Psychological factors, immune function and recovery from major surgery.
OBJECTIVE
This study used a prospective design and the technique of structural modelling to examine the complex interrelations between psychological factors, immune status and complications after major surgery.


METHODS
Twenty-nine women scheduled for elective cholecystectomy were studied prospectively. Information regarding medical history, health practices, life stressors, and coping strategies was obtained two weeks prior to admission. At this initial meeting, as well as three days after surgery, and at one month follow-up immunological tests were performed and the level of psychological distress was assessed. The study additionally included measures of post-operative complications, and infections and negative effect during follow-up.


RESULTS
Pre-operative immune status emerged as a key variable exerting strong effects on subsequent immune function and, thereby producing significant, indirect effects on every recovery variable. Pre-operative distress was directly linked to increased mood disturbance at follow-up. Moreover, distress significantly influenced immune function both before and after surgery, which mediated a significant impact on most recovery variables. Active coping behaviour directly increased the risk of a complicated recovery.


CONCLUSIONS
The study demonstrated that distress-induced changes in immune functioning have clinical relevance. Overall, the present findings suggest that recovery from surgery is facilitated in patients with a well-functioning immune system, a low-level of pre-operative distress and a passive coping disposition.
1School of Psychiatry, University of New South Wales, Sydney, Australia.
Ute
U
Vollmer-Conna
2School of Psychology, University of New South Wales, Sydney, Australia.
Kevin D
KD
Bird
3Department of General Surgery, Prince of Wales Hospital, Sydney, Australia.
Bryan W
BW
Yeo
3Department of General Surgery, Prince of Wales Hospital, Sydney, Australia.
Philip G
PG
Truskett
2School of Psychology, University of New South Wales, Sydney, Australia.
Reginald F
RF
Westbrook
4Inflammatory Diseases Research Unit, School of Medical Sciences, University of New South Wales, Sydney, Australia.
Denis
D
Wakefield