Researchers Receive $ 6.2 Million Grant to Launch Perioperative Mental Health Center

Clinicians and researchers at Washington University School of Medicine in St. Louis received a four-year, $ 6.2 million grant from the National Institute of Mental Health to launch a center designed to help improve patients’ mental health surgical patients, especially older surgical patients. The center will conduct studies to identify and treat depression and anxiety in surgical patients.

The average person will have nine surgeries in their lifetime, and the periods before, during, and after surgery are considered high risk to mental health, especially in older people. Depression and anxiety are particularly common in older surgical patients; previous research has shown that about 40% of older surgical patients have mental health issues that can affect their quality of life and hamper recovery after surgery.

Identifying and treating depression and anxiety in surgical patients is the goal of a team of clinicians and researchers at the Washington University School of Medicine in St. Louis. The team received a $ 6.2 million four-year grant from the National Institute of Mental Health of the National Institutes of Health (NIH) to launch a center designed to help improve the mental health of operated patients .

The new Center for Perioperative Mental Health is the first center of its kind funded by the NIH in the United States. The center will conduct clinical trials, initially involving three types of surgery: joint replacement and cardiac and cancer surgery. Led by scientists from psychiatry, anesthesiology, general surgery, orthopedic surgery and the University Institute of Informatics, the center aims to protect and improve the mental health of patients during stressful periods just before, during and after an operation, with particular emphasis on the elderly.

“More older adults are having surgery than ever before, and rates of clinically significant depression and anxiety are about four times higher in those who have surgery than in older adults who are not.” said Eric J. Lenze, MD, Wallace and Lucille. K. Renard Professor of psychiatry and one of the centre’s co-principal investigators. “This new center is designed to allow clinicians and scientists to collaborate to prevent adverse mental health effects in older people who need surgery.

Each year, some 50 million people in the United States – and 350 million worldwide – undergo surgery. These operations can be life changing events.

Older surgical patients in particular face difficult hospital stays, often followed by stays in rehabilitation centers and then home visits by nurses and therapists. Lenze said the upheaval caused by an operation, frequent changes of location after surgery, and interactions involving drugs can contribute to the patient’s cognitive decline, confusion and mood issues.

The whole process can be overwhelming for patients, according to the centre’s other principal investigator, Michael S. Avidan, MBBCh, Dr. Seymour and Rose T. Brown professor and head of the department of anesthesiology. He said the growing awareness that mental health contributes to better overall health outcomes for operated patients is one of the main reasons he and Lenze worked to form the new center.

People are more than the parts of the body they repaired during surgery, more than the heart valves or arthritic joints. Our plan with this center is to treat patients holistically and address factors that affect health and well-being. Although ours is a center with a mental health focus, we see our role in a much larger context, with the overall well-being of patients as the focus. “

Michael S. Avidan, MBBCh, Dr Seymour and Rose T. Brown Professor and Head of Department of Anesthesiology

The researchers wish to identify and evaluate ways to improve the mental health of vulnerable surgical patients and invite researchers in the Faculty of Medicine to design pilot studies that could help advance these goals. The center will allocate at least $ 80,000 per year to help launch such pilot projects. The first group of pilot project proposals is expected on September 1.

Other members of the centre’s leadership team include Mayola Rowser, PhD; Dean Jack Taylor of the Goldfarb School of Nursing at Barnes-Jewish College; Marilyn E. Schallom, PhD, Research Director for Patient Care Services at Barnes-Jewish Hospital; and Jennifer Carron, executive director of patient experience at BJC HealthCare. Joanna Abraham, PhD, assistant professor of anesthesiology, is the principal investigator of the methodological core of the center, and Katie Holzer, PhD, instructor in anesthesiology, is the administrative director of the center.

In addition to higher rates of anxiety and depression, many older patients who undergo surgery experience cognitive decline. Often, older surgical patients take medications that have been associated with confusion, falls, and other side effects following surgery.

“The center will study and test interventions to help improve cognitive health as well as other aspects of mental health,” Lenze said. “We believe that improvements in these areas will improve recovery, reduce the need for patient readmission, and reduce the risk of falls and confusion after surgery.”

Lenze and Avidan believe that efforts to improve the mental health of operated patients are particularly important after more than a year of the COVID-19 pandemic.

“The pandemic has put enormous pressure on people,” Avidan said. “As stressful and anxiety-provoking as major heart surgery or cancer surgery might have been for an elderly person five years ago, having experienced the pandemic with their social isolation and other fears related to the virus has amplified the challenges. It turns out that we ‘re relaunching this effort at a time when the need is even greater than it was when we first came up with the idea for this center. “

The two also believe that by bringing together people from different specialties, the center can approach mental health issues in elderly surgical patients from multiple angles, making it more likely that solutions will emerge.

“We see this center as a vehicle for rapidly improving care, rather than just a vehicle for scientific discovery,” Avidan explained. “Scientific discovery is, of course, very important to us, but our goal is to rapidly translate all discoveries that can be of benefit to surgical patients and to society.”