Adult Post-operative Mental Health Outcomes Following Abdominal and Orthopedic Surgeries: A Scoping Review.

Mental health is an essential component of psychological well-being that enables individuals to cope with adversity, function effectively, and participate actively in their communities. Globally, more than 1 billion individuals live with a mental health condition [ 1 ]. Severe life stressors, ranging from acute medical events such as myocardial infarction to major interventions such as coronary artery bypass surgery, can lead to severe psychiatric conditions, including major depression, anxiety, and post-traumatic stress disorder (PTSD) [ 2 ]. Consequently, surgery must be recognized not only as a physiological disruption but also as a significant psychological stressor [ 3 ]. According to Hsu et al., surgical patients are highly susceptible to pre-operative anxiety, post-operative depression, and PTSD [ 4 ]. Therefore, integrating mental health services into routine surgical care is essential to facilitate holistic recovery. Conversely, surgical intervention may also yield psychiatric benefits; a cohort study evaluating patients with refractory epilepsy demonstrated that those who underwent successful surgical management experienced a significant reduction in psychiatric symptoms one year after intervention compared with counterparts deemed unsuitable for surgery [ 5 ]. Nevertheless, adverse psychological outcomes remain pervasive, with 64% of hospitalized post-surgical patients experiencing depression, and 74% contending with severe anxiety. Furthermore, 13%-47% of patients navigate post-operative depression, a burden frequently exacerbated by physical discomfort, financial constraints, or a deficit in psychosocial support [ 6 ]. A systematic review and meta-analysis of 50 studies focusing on patients who developed post-surgical complications revealed that two-thirds of the patients experienced adverse psychological outcomes, even after controlling for pre-surgical psychological status. Furthermore, a one-year follow-up demonstrated that participants across half of the included studies exhibited poor psychological well-being [ 7 ]. Complementing these findings, a prospective study focusing on post-surgical patients with pre-existing severe mental illness revealed that a post-operative mental health visit significantly reduced the odds of hospital readmission. These findings highlight surgery as a potential psychological stressor, while highlighting the critical importance of post-operative mental healthcare in optimizing overall surgical outcomes [ 8 ]. Numerous studies have illustrated the detrimental impact of trauma and orthopedic interventions on psychological outcomes, specifically depression [ 9 , 10 ], anxiety [ 11 , 12 ], and PTSD [ 13 , 14 ]. This vulnerability is not restricted to adults; a cohort study evaluating pediatric patients who underwent adenoidectomy or tonsillectomy revealed a significant increase in stress-related conditions, such as PTSD, relative to their matched, unexposed counterparts [ 15 ]. Many research works have highlighted the impact of post-operative mental health on surgical outcomes, and some have delved further to uncover the post-operative challenges and poor outcomes recorded among patients with a history of pre-surgical severe mental illness [ 16 - 19 ]. The relationship between surgery and mental health has not been fully established [ 4 ]. Therefore, we aimed to map the breadth and depth of evidence on the effects of surgery on mental health challenges. Specifically, we aimed to elaborate on the tools used to evaluate mental health, identify gaps in the literature, elaborate on various emerging diagnostic and therapeutic approaches, and explore the factors influencing these mental health conditions.

Methods Study Design This study was conducted and reported in accordance with the Joanna Briggs Institute (JBI) manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting checklist, respectively. This scoping process was designed to comprehensively map the breadth and depth of the existing evidence in this field, establish a rigorous foundation for future primary studies, identify critical knowledge gaps, and clarify the core concepts and definitions used in the literature. Methodological quality and risk-of-bias assessments were not conducted because critical appraisal is not a mandatory component of scoping reviews [ 20 ]. The execution of this study followed a structured, sequential workflow: defining and refining the research query, establishing strict inclusion and exclusion criteria, performing a comprehensive literature search and article selection, extracting and analyzing data, and synthesizing and presenting the final insights. Elaboration of Review Framework The review question was structured using the Population (P: adult), Concept (C: mental health outcomes), Context (C: abdominal or orthopedic surgery) framework recommended by the JBI. Eligibility Criteria Inclusion criteria: We included original research articles that (1) evaluated adult patients aged ≥18 years who underwent a major abdominal or orthopedic surgery; (2) investigated the development of a post-operative mental health condition, specifically depression, anxiety, or PTSD as primary outcomes; (3) assessed these psychological outcomes perioperatively or up to two years following surgery; (4) were published in the English language; and (5) were indexed in the databases between January 2000 and May 2026. Exclusion criteria: We excluded (1) studies exclusively evaluating well-established or pre-existing mental health conditions before surgery, (2) publications incorporating pediatric mental health outcomes following surgical interventions, (3) studies for which the complete abstract, full-text article, or post-operative monitoring timeline could not be retrieved, (4) research proposals or protocols outlining intended mental health outcomes; (5) and articles on mental health outcomes in patients undergoing spine and abdominal vascular surgeries. Information Sources and Search Strategy A comprehensive search approach was adopted, and information was retrieved from PubMed, PsycINFO, the Cochrane Library, and Web of Science, alongside gray literature sources such as the CDC, WHO, and relevant NGO publications. Search themes were combined using Boolean operators (AND/OR/NOT), using "AND" to intersect distinct themes, "OR" to capture alternative terminologies within a theme, and "NOT" to exclude irrelevant themes. We manually screened the reference lists of all included publications and related systematic review titles to identify additional articles relevant to our topic, thereby enhancing search sensitivity and specificity. The search strategy was continuously refined to optimize data retrieval. The literature search was performed from April to May 2026 by two independent reviewers. Conflicts were resolved by a third reviewer, and particularly difficult decisions were discussed with the entire review team until a consensus was reached. Keywords and controlled vocabulary were systematically derived for each domain. To maximize search sensitivity, Medical Subject Headings (MeSH) terms were paired with text words, truncations, and wildcard characters. Individual search components were developed into four discrete keyword groups (#1, #2, #3, and #4) within the advanced search builder. These independent groups were subsequently merged in the search history using the Boolean operator AND to execute the final comprehensive search (#1 AND #2 AND #3 AND #4). #1: "Adult/psychology"[Mesh] OR adult* OR elder* OR middle age; #2: abdominal surg* OR abdominal procedur* OR cholecystectom* OR pancreatectom* OR appendectom* OR gastrectom* OR laparotom* OR perforation repair OR intestinal anastomosis OR bariatric surg* OR by-pass surgery OR laparoscop* OR colectom*, hepatectom* OR hysterectom* OR gastrointestinal cancer resection OR joint replacement OR arthroplasty OR fracture repair OR fracture fixation OR osteosynthesis OR amputation OR cesarean delivery OR cesarean section OR myomectom* OR ovarectom* OR hysterectom* OR nephrectom* OR cystectom* OR ureteroplast* OR urological procedures OR urolological surg*; #3: Mental health OR psychological well-being OR emotional well-being OR mood disorders OR depression OR anxiety OR post-traumatic stress disorder OR psychosocial OR psychiatric; #4: outcome OR following surgery OR after surgery OR postoperative, perioperative. Selection of Studies Citations of interest were imported into Zotero for deduplication. Subsequently, we carried out a two-stage screening process, consisting of a title and abstract screening followed by a full-text review. Initially, titles and abstracts were screened against the pre-established eligibility criteria. Subsequently, a comprehensive full-text review was performed on all potentially eligible articles to confirm their suitability for final inclusion. Any discrepancies or doubts regarding study eligibility were resolved by consulting a third reviewer. This study selection process was visually mapped using a PRISMA-ScR flow diagram (Figure 1 ). PRISMA-ScR, Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A piloted data charting form was used to extract relevant information from the included studies, including author name(s), year of publication, country where the research was conducted, study aim, sample size, clinical characteristics of the study population, methodology, data analysis techniques, and primary outcomes. Analysis and Synthesis of Data Descriptive and thematic approaches were used to analyze the extracted data. The distribution of the included studies was subsequently mapped numerically to illustrate trends based on geographical location, publication year, study design, and target population group. Quality Appraisal A quality assessment of the individual included studies was not conducted, as it is mandatory for a scoping review. However, we described the inherent limitations of the included studies to facilitate a more nuanced interpretation of the findings. Ethical Clearance Formal institutional ethical approval was not required, as this study was a scoping review of secondary data from previously published literature rather than a primary investigation involving human participants. Nevertheless, strict adherence to research integrity and publication ethics was maintained by ensuring that all primary sources were meticulously cited and accurately referenced. Results Study Selection The initial database search yielded 29536 records from PubMed (11731), PsycINFO (12907), Web of science (0), Cochrane (4898) and gray literature (0). After excluding 12602 duplicates, 16934 abstracts and titles were assessed for eligibility and 375 articles were retained for full-text review. Most studies excluded during the full-text review were abstracts for which we could not find the full-text, studies centered on a broader domain like health-related quality of life (HRQOL) after surgery or on surgical outcome and not mental outcome, studies whose follow-up period exceeded two years, or studies, including surgical procedures, that were not in our scope despite sharing same specialty, such as breast surgery, urethroplasty, vagina procedures. We also excluded studies involving spine surgeries, even though they are sometimes performed by orthopedic surgeons. After the full-text review, 86 studies that met the inclusion criteria were included in the final review. Table 1 shows the data extraction chart of the included studies. Characteristics of the Included Studies Publication trends and study designs: Of the 86 studies, the most common were prospective observational studies (n=22), followed by randomized controlled trials (n=21), cross-sectional studies (n=18), prospective cohort studies (n=11), retrospective cohort studies (n=8), case-control studies (3), a retrospective, longitudinal, mirror-image study (n=1), a self-controlled case series (1), and an uncontrolled single arm clinical trial (n=1). Overall, 75.6% (65) of the studies were published from 2015, showing an increasing research interest in the impact of surgery on mental health. There was wide variation in sample sizes, ranging from 19 to 4,228,204 participants [ 42 , 45 ]. Figure 2 shows the number of studies published per year. Characteristics of the Population All studies excluded pediatric patients, some excluded individuals with pre-existing mental health conditions, severe medical comorbidities, or older adults aged ≥65 years, whereas specific orthopedic studies intentionally focused on geriatric populations [ 43 , 62 , 68 , 73 ]. Conversely, certain studies enrolled patients with pre-existing depression and anxiety to analyze pre- and post-operative symptom trends [ 35 , 78 ]. Women constituted the entire cohort in gynecological studies, whereas both genders were well represented across the orthopedic and gastrointestinal surgical categories. Most studies were conducted in high- and upper-middle-income nations, with China being the most highly represented (n=21), followed by the United States (n=14), Turkey (n=7), and Canada (n=7). Notably, limited evidence originated from low-income countries, including three studies from sub-Saharan Africa, two from Nigeria, and one from Ethiopia [ 24 , 44 ]. We found no study in South America. Thus, Asia accounted for most of the literature, followed by North America, Europe, and Africa. Surgical Specialties The included studies were classified into four main surgical categories: gynecological and obstetrical (n=41, including hysterectomies, cesarean sections, and oophorectomies), digestive (n=22, including bariatric surgeries, cholecystectomies, and gastrointestinal oncological resections), orthopedic (n=20, including knee arthroplasty, osteosynthesis, and total hip arthroplasty), and cross-specialty (n=3). Assessment Tools Used Most studies assessed mental health using self-reported, standardized questionnaires to estimate the prevalence and severity of depression. However, few relied on physician assessments coded as the diagnosis using the International Classification of Diseases (ICD)-9-CM code, which records clinical diagnoses for insurance reimbursement. Among the instruments evaluating post-operative depression, the Hospital Anxiety and Depression Scale (HADS) was the most frequently used, followed by the Patient Health Questionnaire-9 (PHQ-9). The HADS features two 7-item subscales: HADS-D for depression and HADS-A for anxiety, with each item scored from 0 to 3, yielding a total subscale range of 0 to 21. Scores ≥8 indicate possible depression, while scores ≥11 signify severe depressive symptoms. The PHQ-9 and the Generalized Anxiety Disorder-7 (GAD-7) scales were used frequently. Both score individual items from 0 to 3, but the 9-item PHQ-9 ranges from 0 to 27, whereas the 7-item GAD-7 ranges from 0 to 21. Since both scales categorize symptoms into minimal, mild, moderate, and severe bands, they are frequently paired. For specific populations, the Edinburgh Postnatal Depression Scale (EPDS) was used exclusively for postpartum depression (though a few postpartum studies used ICD-9-CM codes), while the Geriatric Depression Scale was used solely for elderly patients. Finally, PTSD symptoms were primarily evaluated using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PCL-5), with scores ranging from 0 to 80. The PCL-5 tracks symptom onset, evolution, and severity, with a 5- to 10-point shift indicating reliable change and a 10- to 20-point shift representing clinically significant change. The complete list of the various assessments has been provided in the appendix. Distribution of Evidence Orthopedic surgeries: There was a wide variation in the estimated prevalence and incidence of post-operative depression, with elevated rates reported among geriatric populations, individuals with hip fractures, and patients experiencing surgical complications. The prevalence of depressive symptoms ranged from 10% to 50% [ 65 , 66 , 100 , 103 , 105 ]; however, this prevalence exceeded 50% in some studies, including an investigation conducted during the COVID-19 pandemic that documented a prevalence of 61.8% [ 74 , 102 ]. The incidence of post-operative anxiety symptoms ranged from 4% to 61.7%. The incidence of PTSD symptoms was generally <18%; however, a higher susceptibility was noted among amputees [ 66 , 69 ]. Generally, symptoms of anxiety and depression were ameliorated after surgical intervention involving the successful restoration of mobility [ 62 , 103 , 105 ]. Gynecologic surgeries: Conflicting information was reported regarding the impact of hysterectomies on post-operative depression; while certain studies reported higher rates of depression [ 38 , 50 , 90 ], others highlighted an improvement in depression and anxiety [ 28 , 32 , 93 , 99 ]. The prevalence of post-operative postpartum depression was 30%, a rate exceeding that of women undergoing vaginal delivery; however, no significant difference was noted between women undergoing primary cesarean sections versus repeat procedures [ 76 , 86 , 88 , 89 ]. Cesarean delivery, particularly in emergency situations, resulted in a higher severity of PTSD symptoms than vaginal delivery [ 59 , 75 , 80 ]. Notably, interventions such as informative educational videos regarding cesarean sections reduced pre- and post-operative anxiety, while the administration of esketamine for induction, the playing of music during cesarean delivery, the application of bupivacaine-soaked Spongostan on surgical wounds, and comprehensive pre-operative instructions were associated with reduced severity and lower prevalence of post-cesarean section depression [ 40 , 47 , 49 , 58 , 60 , 84 , 87 ]. Conversely, the administration of general anesthesia was associated with a higher prevalence of depressive symptoms than regional anesthesia [ 42 , 83 ]. Digestive surgeries: Mental health outcomes were generally mixed among patients undergoing digestive surgery, with certain procedures demonstrating higher anxiety and depressive symptom prevalences than others. Following bariatric surgery, the prevalence of depression and anxiety was generally <10%, and post-operative depression and anxiety levels decreased over time [ 23 , 27 , 33 , 35 , 37 ]. Conversely, a study reported significantly higher levels of depression in patients undergoing cholecystectomy for gallstone disease than in untreated controls [ 54 ]. Furthermore, laparoscopic cholecystectomy was associated with higher levels of post-operative anxiety than open surgery, particularly when patients were informed of the procedure well in advance [ 48 , 56 ]. Finally, interventions for gastrointestinal cancers revealed high levels of persistent post-operative depression and anxiety [ 21 , 46 ]. Risk and Protective Factors for Mental Health Conditions Depression and anxiety were more likely to manifest in women, illicit drug users, underweight individuals, patients experiencing pain, geriatric populations, and patients with a history of similar surgical interventions. Furthermore, individuals undergoing major, open, complicated, or oncological surgeries under general anesthesia, and those with low per capita income, lower educational attainment, and minimal or absent social support networks were more vulnerable to depression and anxiety. Conversely, pre-operative counseling, psychotherapy, minimally invasive procedures, and corrective or weight-loss surgeries were protective factors against depression and anxiety. Regarding PTSD, patients undergoing amputations or cesarean deliveries and those experiencing peri-implant fractures demonstrated a significantly higher susceptibility. Finally, the primary risk factors for postpartum depression included multiparity, maternal age ≥30 years, unplanned pregnancy, a history of miscarriages, and the presence of maternal or neonatal postpartum complications [ 26 , 29 , 30 , 31 , 57 , 65 , 77 , 79 , 80 , 83 ]. Emerging Diagnostic and Therapeutic Approaches According to randomized controlled trials, ketamine effectively alleviated post-operative depressive symptoms, while intraoperative music therapy significantly mitigated post-surgical anxiety and depression. Additionally, virtual reality interventions and the pre-operative provision of informative educational videos substantially reduced anxiety levels. In bariatric surgery, tele-behavioral cognitive therapy successfully lowered the severity of anxiety and depression. Similarly, the application of bupivacaine-soaked Spongostan within cesarean section wounds reduced the risk of postpartum anxiety and depression. Finally, functional near-infrared spectroscopy (fNIRS) represented an objective modality for quantifying anxiety severity in geriatric populations. Evidence Gaps There was a wide variation in assessment tools, follow-up durations, and outcome interpretations, which limits the synthesis, comparison, and mapping of results. For example, studies did not unanimously report the incidence (new-onset symptoms), prevalence, evolution of symptoms after surgery compared to pre-operative baseline, and trajectories of symptoms over time following surgery. Few studies originated from low-income countries. Some studies failed to compare outcomes across different surgical specialties, and multinational investigations were not conducted. Furthermore, no experimental studies have been conducted to elucidate the underlying biological mechanisms driving post-surgical mental health outcomes. There were also no standardized assessment scales specifically validated for post-operative mental health outcomes. Finally, urological surgery-specific studies were unrepresented, and studies focusing on PTSD were scarce. Discussion We conducted this scoping review to map the breadth and depth of evidence regarding post-operative mental health following abdominal and orthopedic surgeries. Specifically, we focused on post-operative depression, post-operative anxiety, and PTSD, which are ranked among the most prevalent psychological complications following surgical procedures [ 2 ]. Of 29,536 records retrieved during our search, 86 studies met the inclusion criteria. Prospective observational studies were the most frequent (n=22), followed by randomized controlled trials (n=21) and cross-sectional studies (n=18). Most studies originated from China (n=21) and the USA (n=14). Notably, there was a stark paucity of data from low- and middle-income countries (LMICs), with South America being the least represented continent. The predominance of publications from China and the USA underscores their robust engagement in mental health research. This output aligns with the 2024 Nature Index, which ranked these two nations as global leaders in scientific research [ 107 ]. Among studies on abdominal surgery, one-third focused on gastrointestinal interventions, with particular emphasis on oncological resections and bariatric procedures. This concentration mirrors the escalating global burden of non-communicable diseases such as obesity and malignancy, which are currently two of the most critical public health concerns [ 108 ]. Investigations tracking patients undergoing bariatric surgery revealed that mental health outcomes, specifically symptoms of depression and anxiety, were exacerbated during the immediate perioperative phase but subsequently improved after surgery [ 22 , 27 , 33 - 35 ]. This psychological recovery was significantly more pronounced when bariatric interventions were combined with body contouring surgery [ 36 , 37 ] or when sleeve gastrectomy was preferentially performed over gastric bypass [ 34 ]. This initial post-operative symptom exacerbation may be driven by the immediate impact of surgery as a profound psychological stressor, or the development of early post-surgical complications, as reported by a study on sleeve gastrectomy [ 33 ]. The subsequent long-term improvement in mental health following bariatric interventions can be elucidated by substantial weight loss, an enhanced perception of body image, routine post-operative psychotherapeutic support, and elevated self-esteem, a trajectory further corroborated by the superior mental health outcomes documented following body contouring procedures. Similarly, the acute post-operative phase in orthopedic patients was characterized by elevated rates and peaking levels of depression compared to that at the pre-surgical baseline [ 64 , 65 , 74 ]. Orthopedic procedures were the third most highly represented surgical category in this review. However, the lower occurrence of orthopedic surgery in our review is attributable to the fact that spine surgery studies and investigations evaluating HRQOL, though substantial in volume, were excluded from our study. HRQOL is a multidimensional, subjective and objective evaluation of the physical and psychological well-being of a patient experiencing a specific clinical condition, with the physical domain inherently predominating [ 109 ]. The six core dimensions of HRQOL include physical functioning, role limitations, bodily pain, mental health, vitality, and social functioning [ 110 ]. Since rehabilitation and restoration of physical function are of paramount importance in orthopedics, a vast body of literature focusing on HRQOL was retrieved and excluded from this study due to the complexity of mapping such extensive data within our specific scoping framework. The findings regarding depressive outcomes in patients who underwent a hysterectomy were conflicting. Among the eight studies comparing pre- and post-operative depression after hysterectomy, four revealed an improvement in depression levels [ 28 , 32 , 93 , 99 ], one revealed no significant difference between pre-operative and post-operative depression [ 51 ], and three reported worsened post-surgical depression levels [ 38 , 50 , 90 ]. Although clinically indicated hysterectomy can be beneficial, such as in cases of malignancy, endometriosis, or pyometra [ 111 ], it can also be detrimental to psychological well-being, particularly for women who are sexually active, still menstruating, or desiring children. Notably, instrumental and cesarean deliveries were associated with higher levels of anxiety, depression, and PTSD compared to vaginal deliveries [ 59 ]. This disparity may be elucidated by the fact that operative deliveries are more invasive, more costly, and frequently performed in emergency situations without adequate pre-operative psychological preparation. Furthermore, these interventions are often associated with higher risks of maternal and fetal morbidity and mortality. Conversely, repeat cesarean sections were not associated with higher levels of depression when compared to primary cesarean deliveries [ 52 ]. This specific outcome may be attributable to the psychological phenomenon of desensitization. Across specialties, female sex, advanced age, a lack of social support, low socioeconomic status, and a history of psychiatric conditions emerged as prominent factors influencing psychological disorders [ 57 , 65 ]. The studies that documented the highest prevalence rates of depression and anxiety were conducted in Ethiopia and Tunisia, respectively, among orthopedic patients undergoing arthroplasty [ 63 , 74 ]. Findings within LMICs among arthroplasty cohorts who are predominantly geriatric patients underscore the reality that age and lower socioeconomic status significantly amplify the risk of psychiatric morbidity. Geriatric patients frequently present with multiple medical comorbidities, such as neurodegenerative diseases, and exhibit reduced resilience to surgical stress alongside higher rates of post-operative complications. This multifaceted vulnerability elucidates the high rates of depression observed among older adult patients undergoing total hip arthroplasty. A common finding across surgical specialties was that specific operative approaches for the same underlying condition resulted in significantly superior psychological outcomes. Examples included sleeve gastrectomy over Roux-en-Y gastric bypass [ 34 ], bariatric surgery combined with body contouring over bariatric surgery alone [ 36 , 37 ], open surgery over laparoscopic cholecystectomy [ 48 ], conservative management over surgical intervention for cholelithiasis [ 54 ], the direct anterior approach and the Orthopädische Chirurgie München techniques over the conventional lateral approach [ 71 ], intramedullary nailing with early weight-bearing over open reduction and internal fixation [ 62 ], spinal anesthesia for cesarean delivery over general anesthesia [ 42 , 83 ], and vaginal delivery over cesarean section [ 59 ]. Consequently, to ensure holistic patient care, it is essential to carry out large-scale studies to investigate these findings, which will inform decisions regarding balancing surgical indications and clinical techniques with potential post-operative mental health outcomes, particularly in patients presenting with identifiable risk factors. One of the key findings of this review was the marked heterogeneity across the assessment tools, reported prevalence rates of psychological outcomes, and chronological timing of post-surgical mental health evaluations. Most investigations relied heavily on self-reported screening inventories, whereas only a limited number of studies integrated healthcare provider assessment instruments or prescription medication databases. Furthermore, a nominal subset of studies implemented objective physiological measures, such as salivary cortisol levels and fNIRS, to quantify anxiety severity. The EPDS was the only clinical instrument consistently and unanimously deployed across all studies within a specific domain to evaluate postpartum depression. However, the diagnostic threshold used to define major depression varied significantly between investigations, with individual studies adopting cut-off scores of 9, 10, 11, 12, or 13 and above. This diagnostic variability ultimately complicates a precise and unified estimation of the true prevalence of post-operative postpartum depression. Implications This study provides critical insights into the impact of surgical interventions on the mental health of patients undergoing abdominal and orthopedic procedures. The findings highlight gaps in the continuum of care, particularly regarding common emergency and elective procedures such as appendectomy, intestinal obstruction resection, gastrointestinal perforation repair, urological surgeries, laparotomy for ectopic pregnancy, and operations for ovarian cyst torsion or rupture. Therefore, targeted investigations evaluating the post-operative mental health needs of patients undergoing these prevalent abdominal and orthopedic surgeries are urgently needed. Furthermore, given that specific surgical techniques might yield superior psychological outcomes and that mental health significantly influences surgical recovery, it is essential to conduct large-scale comparative studies. These investigations should evaluate the outcomes of different operative approaches while strictly controlling for baseline psychological status, as observed clinical differences may be driven by confounding variables or effect modifiers. Although certain procedures are inherently more traumatic than others, future research must evaluate PTSD among patients undergoing abdominal surgeries other than cesarean sections, and orthopedic interventions beyond amputations and brachial plexus injuries. Finally, this review underscores the necessity for large-scale, multinational studies to adequately investigate the efficacy of perioperative interventions designed to mitigate anxiety and depression, including the administration of certain intraoperative N-methyl-D-aspartate (NMDA) receptor antagonists to attenuate post-operative depression, the application of local anesthetic-impregnated dressings for wound care, and the implementation of virtual reality gaming during spinal anesthesia. Our findings inform surgeons of the critical need to incorporate patients' psychological well-being when choosing between surgical or anesthesiologic techniques, managing surgical complications, determining the indication to operate, and addressing expected delays in patient recovery. This integration is crucial because post-operative complications, alongside specific surgical and anesthesiologic approaches, could directly influence mental health, which could delay recovery and detrimentally affect overall surgical outcomes. Furthermore, this study underscores the need for a structured, multidisciplinary approach involving surgeons, anesthetists, psychiatrists, and psychologists across the pre-, intra-, and post-operative phases to optimize clinical and psychological outcomes, thereby ensuring holistic patient care. This review also underscores the need for patient-centered care and thorough pre-operative preparation. Before surgical intervention, it is essential to identify individuals presenting with prominent risk factors for psychological distress, determine the optimal volume and timing of procedural information to be shared, and provide patients with targeted educational materials such as informative brochures and videos. Furthermore, psychological therapies and careful selection of optimal surgical and anesthetic techniques should be prioritized during this phase. Intra-operatively, the surgical team could implement evidence-based strategies to mitigate stress, such as intraoperative music therapy, virtual reality gaming for patients undergoing procedures under regional anesthesia, the administration of certain intraoperative NMDA receptor antagonists as anesthetic adjuvants, and the application of local anesthetic-impregnated dressings for wound care. Following surgical intervention, patients must be closely monitored within a structured post-operative framework to facilitate the early identification of psychiatric symptoms and ensure the timely delivery of indicated therapeutic support. Strengths and Limitations This scoping review possesses several methodological strengths. It comprehensively maps evidence for multiple post-operative psychiatric conditions across diverse surgical specialties, successfully capturing overarching clinical trends and localized variations. By incorporating a wide range of study designs, the review effectively details the breadth and depth of the existing literature while clearly delineating critical gaps in evidence. Furthermore, evaluating multiple concurrent mental health conditions provides a more holistic overview of post-surgical psychopathology, acknowledging that psychiatric morbidities frequently co-exist. The inclusion of studies published from 2000 to 2026 offers a comprehensive trajectory of how this research landscape has evolved over the last quarter-century, establishing a robust foundation for future investigations. Finally, adopting a highly systematic approach by adhering to the PRISMA-ScR reporting checklist ensures strict methodological transparency and reproducibility. Nevertheless, this scoping review also has some limitations. The marked heterogeneity in study designs, assessment tools, and the chronological timing of evaluations precluded a direct comparison across investigations and prevented a formal meta-analytical synthesis of the findings. Furthermore, the exclusion of systematic reviews and studies focusing primarily on HRQOL may have constrained the overall scope of the mapped evidence. The restriction of our search to English-language publications may lead to the omission of relevant data published in other languages. Additionally, the inability to retrieve full-text articles for specific abstracts or to access papers published behind commercial paywalls is a potential source of selection bias that could impact the comprehensiveness of our findings. Finally, in strict accordance with the scoping review methodology, no formal critical appraisal or risk-of-bias assessment was performed on the included primary studies, which limits the ability to definitively gauge the methodological quality and underlying bias of the compiled evidence.

Post-operative psychological disorders are prevalent among surgical patients and can significantly impair recovery trajectories and overall clinical outcomes. A multifaceted interaction exists between surgical interventions and mental health, mediated by psychosocial stressors, somatic symptoms, and individual patient vulnerabilities. Post-surgical psychological outcome optimization depends on a comprehensive care continuum, including rigorous individual risk assessment and mitigation, targeted pre-operative counseling, and evidence-based intraoperative strategies, such as the selection of optimal anesthetic and surgical techniques, use of neuroprotective adjuvants, and implementation of stress-reduction measures during regional anesthesia. Furthermore, ensuring meticulous post-operative monitoring to prevent surgical complications, maintaining a high index of clinical suspicion for psychiatric distress, and delivering timely psychosocial interventions are critical components of patient-centered care. Ultimately, the integration of structured mental health services into routine surgical care is essential to facilitate holistic patient recovery and enhance overall surgical success. Finally, there is an urgent need to develop and standardize specific mental assessment tools and reporting protocols for post-surgical patients.