The edition · General Surgery
After a postoperative complication, new mental health disorders were more common for a year
An Ontario study of over a million operations links complications to later mental health disorders, mostly in patients with no prior history. Emergency cholecystectomy got safer over a decade, but organ-space infection more than doubled, and robotic surgery for acute cholecystitis bailed out slightly more often at higher cost.
The edition in brief
In 1.17 million Ontario adults undergoing 25 common operations, a 30-day complication was associated with new or worsening mental health disorders within a year (6.2% vs 4.9%; adjusted OR 1.28), strongest in the first month (aOR 1.77) and confined to patients without a prior psychiatric history. It is observational, but it argues for asking about mood and sleep at follow-up after a complicated course. US NSQIP data on 231,048 non-elective cholecystectomies from 2015 to 2024 show adjusted 30-day mortality falling from 0.59% to 0.38%, with fewer reoperations and major complications, while organ/space surgical-site infection rose from 1.02% to 2.59%, a trend that needs explaining locally. In 384,617 admissions for acute cholecystitis in two US states, robotic cholecystectomy (4% of cases) had slightly more bailouts than laparoscopy (1.7% vs 1.4%), similar bile duct injury, and higher one-year costs. A single-centre series of 639 women with cT1N0 hormone receptor-positive lobular breast cancer and normal axillary ultrasound found nodal disease in 17.7%, close to the rates in the SOUND and INSEMA trials, which supports discussing sentinel node omission in this group too. The pearl is on subtotal cholecystectomy as a planned safe exit.
Emergency cholecystectomy grew safer over a decade, but organ-space infection more than doubled
Check whether organ-space infection after emergency cholecystectomy is rising in your unit and why.
Robotic cholecystectomy for acute cholecystitis: slightly more bailouts, same bile duct injury, higher cost
For acute cholecystitis, robotic surgery offers no clear safety gain over laparoscopy and costs more; choose by team experience.
Lobular breast cancer eligible for SOUND had node rates close to the trials
Consider lobular cancers that meet SOUND criteria for the sentinel node omission discussion, weighing lymphovascular invasion and grade.
Subtotal cholecystectomy is a planned exit, not a failure
Choose a bailout early when the critical view of safety cannot be reached, and plan for its known complications.
A postoperative complication was linked to new mental health disorders within a year
Consider screening for new mood and anxiety symptoms at follow-up after any significant postoperative complication, especially in the first month.
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