Surgery, Complications, and Quality of Life

A Longitudinal Cohort Study Exploring the Role of Psychosocial Factors

Stephanie Archer, PhD; Anna Pinto, PhD; Sabine Vuik, PhD; Colin Bicknell, MD, FRCS; Omar Faiz, MBBS. FRCS; Ben Byrne, PhD; Maximilian Johnston, PhD; Petros Skapinakis, MPH, PhD; Thanos Athanasiou, PhD, FETCS, FRCS; Charles Vincent, PhD; Ara Darzi, FMedSci, FACS, FMedSci FRS, KBE


Annals of Surgery. 2019;270(1):95-101. 

In This Article

Abstract and Introduction


Objective: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).

Background: Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively.

Methods: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study.

Results: Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.

Conclusions: Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.


Surgical complications range from seemingly minor incidents that resolve relatively quickly and without consequence to more serious events that require multiple interventions, delay patients' discharge and may lead to multiorgan failure, longstanding disability or even death.[1] In addition to the physical harm caused to patients, surgical complications can lead to psychological distress and worse quality of life (QoL).[2,3] A recent systematic review reported that patients who suffered surgical complications had significantly worse postoperative wellbeing than patients with an uncomplicated recovery, even after controlling for a range of clinical and demographic factors.[4]

Although the impact of a surgical complication will depend on the severity of the complication itself and the amount of pain and disability that it causes, either temporarily or permanently, psychosocial factors, such as threat appraisal, coping style, and social support can have a significant impact on how people deal with stressful events,[5–7] including surgery—even when surgical complications do not arise.[8,9] To date, the impact of psychosocial factors on moderating the effect of surgical complications on wellbeing remains unknown. In light of this, the aim of the research presented here was to determine how surgical complications impact on QoL. In addition, we aim to explore what influence clinical, socio-demographic and psychosocial factors, in particular the amount of social support a person experiences and their individual coping style, may have upon QoL. We anticipate that understanding the implications of surgical complications for patients' wellbeing and the factors that determine patients' reactions to them will shed light on how to better support patients who suffer medical harm.