Abstract

Surgical hospitalization can be a highly stressful event that compromises both the physical and psychological well-being of a patient. Current correlational evidence suggests that certain psychological characteristics and coping strategies shown by patients may be predictive of poor postsurgical adjustment including physical complications (e.g., bleeding or infection) and extended length of hospital stay, as well as pain and emotional distress. This evidence underscores the need to identify antecedent factors that may eventually be used to facilitate postsurgical adjustment. Accordingly, the present study examined the types of hospital events that individual surgical patients perceive as stressful, the appraisal and emotional responses elicited by these events, and the types of coping strategies used to deal with them. These variables were assessed at multiple points before and after surgery so that prospective relationships could be examined. The principle aim was to identify variables that were most predictive of postsurgical recovery. Data were collected on a series of 52 male and 23 female adult patients admitted for elective general surgery at the Royal Victoria Hospital in Montreal, Quebec. At four assessment points, all patients reported their appraisal, emotional, and coping responses to three types of individualized events during a specified period during their hospitalization: (1) the most unpleasant event that they had personally encountered, (2) the least unpleasant event, and (3) a preselected pain event. Outcome and recovery measures included medication use, physiological state, incidence of complications, and length of postsurgical stay. Path analysis (LISREL) for responses pertaining to the pain event revealed that appraisal, emotion, and coping variables loaded highly on a single construct (Psycho-affective Response) which, in turn, was predictive of a single construct (Outcome) that was found to represent recovery and physiological measures. LISREL results revealed that patients who endorsed a cognitive coping strategy subsequently demonstrated better courses of recovery (e.g., less use of analgesics, shorter postsurgical stay). Moreover, patients who endorsed a challenge appraisal of the pain events subsequently had less need for postsurgical analgesics and fewer pain reports. Multivariate analyses of covariance (MANCOVAs), controlling for type of surgery, that were conducted on patients' endorsements for the most unpleasant events confirmed the association between good outcome with both a challenge appraisal and cognitive coping method. These and related findings suggest potential targets for intervention aimed at improving patients' hospitalization experience and subsequent recovery from surgery