Social Connectedness and Patient Recovery after Major Operations
Received 2 May 2007; received in revised form 24 July 2007; accepted 27 August 2007. published online 12 November 2007.
Background
Social connectedness is thought to play an important role in overall health and well being. We hypothesized that social network size and other measures of social connectedness would predict perceived pain intensity, unpleasantness, and anxiety in veterans recovering after major thoracic or abdominal operations and influence postoperative complications and length of stay.
Study Design
Six hundred five patients from two Veterans Affairs’ medical centers who participated in a randomized controlled trial of massage as adjuvant treatment for postoperative pain were the subjects of this study. Subjects’ social networks were assessed by the numbers of friends or relatives an individual had and how frequently contact was made with members of their social network. Subjective outcomes were rated with visual analogue scales for 5 postoperative days. Daily opiate use, postoperative complications, and length of stay were also recorded.
Results
Mean (±SD) age was 63.8 years (±10.2 years) and 98.5% of participants were men. Those reporting a greater social network were older and had lower preoperative pain intensity, unpleasantness, and state and trait anxiety (p < 0.001). Considerably less pain intensity, unpleasantness, and opiate use were associated with increasing social network size during the first 5 postoperative days. After adjusting for preoperative values of pain and anxiety, these relationships were no longer statistically significant. Smaller social network size was associated with the likelihood of length of stay ≥ 7 days (p = 0.03).
Conclusions
These findings suggest that the effect of social networks on surgical outcomes can be mediated by their effect on levels of preoperative pain and anxiety. Patients should be screened preoperatively for pain and anxiety because these are strong predictors of a more difficult postoperative recovery.
Center for Practice Management and Outcomes Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI; Center for Statistical Consultation and Research, The University of Michigan, Ann Arbor, MI; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Departments of Anesthesiology and Physical Medicine and Rehabilitation, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI.
Correspondence address: Daniel B Hinshaw, MD, FACS, Sections of General Surgery, Geriatrics and Palliative Care Program, VA Ann Arbor Healthcare System and Department of Surgery, University of Michigan, 2215 Fuller Rd, Ann Arbor, MI 48105.
Competing Interests Declared: None.
Supported by a grant from the Department of Veterans Affairs Health Services Research and Development IIR 01-197-1.
ABSTRACT