Receiving counseling or other forms of psychological support before surgery improves patient outcomes, reducing pain, anxiety and depression after the procedure, a new study found.
UCLA Health plastic surgeon Justine Lee, MD, PhD and colleagues analyzed 20 randomized controlled trials from 2004 to 2024 to assess the effects of psychotherapy on post-surgical outcomes, including pain, length of hospital stay and mental health. The study, led by medical student Anne Hall and published in Annals of Surgery, found widespread benefit, regardless of what type of psychotherapy patients received or what kind of surgery they had.
“We call it prehabilitation, which is basically before surgery, instead of rehab after surgery, to maximize their mental health,” Dr. Lee says. “We saw that any type of psychological prehabilitation made surgical outcomes better … and that’s across all surgeries.”
The study analyzed outcomes of 2,376 Medicare beneficiaries age 50 and older who underwent a variety of surgical procedures, from coronary bypass to radical mastectomy to knee replacement.
All patients who received psychological support before the procedure benefitted, whether it was individual or group counseling provided by a psychologist or a workshop led by a health coach, the study found.
Receiving counseling – an average of 4.5 sessions, with at least two occurring pre-operatively – led to shorter hospital stays, less pain and improved mental health after surgery.
Psychology is something surgeons don’t typically think about as a way to improve patient outcomes, says Dr. Lee, but this analysis shows “we should be working on prehab for all surgical patients.”
“Everybody, for any kind of surgery, would benefit from improvement in mental health care,” she says.
Broader benefits
There could also be implications for reducing post-surgical opioid use, Dr. Lee adds. Anxiety and depression are known risk factors for persistent opioid use after surgery, and the study found that psychological prehabilitation reduced these mental health conditions.
Patients also experienced less pain when they received counseling before surgery.
The benefits extend beyond individual patients to broader health care costs, as patients who received prehabilitation required shorter post-surgery hospital stays – an average of 1.62 days less, according to the study.
Dr. Lee and colleagues have developed a pilot prehabilitation program for UCLA Health patients and are seeking grant funding to study its efficacy.
“The bottom line is there’s the mind-body connection,” Dr. Lee says. “The mind affects how you heal from surgery – not just how you feel, but how you heal.”
