Undergoing surgery may lead to a small decline in physical health, but mental health does not suffer, a new study finds.

In the UK’s Whitehall II study, 7920 adults completed multiple Short Form 36 (SF-36) quality-of-life assessments from 1997 to 2016. Compared with no hospital admission, major surgery was significantly associated with a mean 0.79-point decrease in the physical component summary (PCS) but no change in the mental component summary (MCS) of SF-36, Robert D. Sanders, MBBS, PhD, of Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia, and colleagues reported in JAMA Surgery. In a subgroup analysis of patients who had emergency vs nonemergency surgery, only PCS significantly declined (-0.91 points).

In contrast, a major medical admission was significantly associated with both a mean 1.46-point decrease in PCS and a 0.47-point decrease in MCS, compared with no admission.

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The investigators also calculated the odds of a substantial decline in quality of life, defined as more than 2 standard deviations from a predicted trajectory. Having major surgery, medical admission, or both was significantly associated with 1.8-, 2.2-, and 2.9-fold increased odds of a substantial decline in PCS, respectively, compared with no admission. Only patients with both a medical and a surgical admission had significant 2.0-fold increased odds of a substantial decline in MCS.

Overall, the effect sizes were below the clinically relevant threshold of 5 points, Dr Sanders’ team explained. Compared with a stroke-related admission, a control condition, impairments in quality of life from major surgery and major medical care were smaller.

“Major medical admissions were associated with a decline in both mental and physical quality of life, while major surgical admissions were only associated with changes in the physical components of quality of life,” the investigators concluded.


Krause BM, Manning HJ, Sabia S, et al. Association of major surgical admissions with quality of life: 19-year follow-up of the Whitehall II longitudinal prospective cohort study. JAMA Surg. Published online January 26, 2022. doi:10.1001/jamasurg.2021.7132