Feeling anxious before surgery? Anxiety can harm healing but innovative mental health support could help

Feeling anxious before surgery is normal — but for many patients, it goes far beyond nerves. There is a growing body of research showing that poor mental health before surgery can derail recovery in ways that extend far beyond the operating room.

For example, in recent research, my colleagues and I found that anxiety and depressive symptoms before surgery are linked to poorer surgical outcomes. This includes higher complication rates within 30 days and even increased risk of death within a year.

On top of this, many patients rank anxiety as one of the worst parts of their surgical experience, worse than pain or other aspects of surgical recovery.

Both patients and clinicians identify a need for mental health support, yet this need is often overlooked. As an expert in perioperative mental health, I have some solutions to offer.

Demand for surgery is accelerating

The growing number of surgical patients — driven by an aging population, rising rates of chronic diseases and advancements in medicine — has intensified pressure on the health-care system.

Rising demand has led to longer wait times and increases in surgery delays and cancellations. This situation has been made even worse by the COVID-19 pandemic. Patients can be left suffering in limbo for weeks, months or even years.

My colleagues and I have found these surgery delays and cancellations to be linked with even further negative impacts on mental and physical health. Patients are getting worse while they wait.

While this growing backlog represents a significant challenge, it also presents an opportunity.

The opportunity

The surgical waiting period, which is too often prolonged, offers a critical window to identify patients at highest risk for poor mental health. Identifying those in need is critical to deliver targeted and scientifically supported psychological treatments. It’s a time when patients are already engaged with the health-care system, motivated to do well and receptive to guidance.

Evidence-based psychological treatments like cognitive behavioural therapy before surgery have been shown to improve outcomes like pain and function.

International organizations, such as the World Health Organization, highlight the importance of including mental health support into hospital settings including surgical care.

In the United States, the Center for Perioperative Mental Health, originating from Washington University, is one of the first large-scale initiatives of its kind aiming to integrate personalized pathways to support mental health for older adults.

As the external advisory chair for this centre, I have seen how initiatives like these can significantly enhance perioperative care and patient outcomes.

Globally, efforts such as pre-habilitation programs — which aim to enhance surgical readiness through exercise, nutrition and mental health support — are emerging. While these represent progress, they are not routinely implemented, often lack integration of evidence-based mental-health care, and show mixed results due to variability in design and delivery.

There is strong evidence linking poor pre-operative mental health to worse outcomes, along with clear patient demand and promising results from existing programs. Yet, perioperative mental health support in Canada remains underfunded and far from standard clinical care.

Mental health continues to be unaddressed in surgical settings.

Leverage technological advancements

Given the significant shortcomings of accessible mental-health care in Canada, creative solutions are critical. One way forward is to make the most of fast-growing technology.

For example, our team has developed an innovative virtual reality (VR) program using patient input and strategies backed by science to support mental health before surgery.

Patients found this both acceptable and helpful. These platforms assist patients to mentally prepare for surgery, familiarize themselves with the environment and feel more in control.

Other large-scale digital initiatives such as the Power Over Pain Portal offer free evidence-based online psychological treatments for pain management from the comfort of your home. And pain management is especially important for those waiting extended periods for many types of surgeries.

Our multidisciplinary team at the University of Manitoba believes these types of digital approaches can be delivered at scale, relatively low cost, and with high patient acceptability and satisfaction. This is not meant to replace human care, but to extend it.

These are not just flashy gadgets but clinical tools with real potential to integrate evidence-based mental health treatments.

Prepare physically and mentally

Health-care systems are often under-resourced, and Canada is no exception. To address this, surgical care should prioritize greater investment in mental health support, including integration of technology. These efforts can better prepare patients physically and mentally for surgery and aid in their surgical recovery.

Mental health is central to surgical outcomes — not secondary. We need a national strategy to fund the research and ultimately routinely apply accessible mental health treatments for surgical patients. This is especially important for those at highest risk.

Patients have told us what they need. The evidence is undeniable. And the opportunity for change has never been greater. We need to build a system that truly cares for the whole patient.