In preparing for surgery, the focus of the doctor and the patient is traditionally on the physical: what the operation entails, how the patient’s affected body part will feel after, and what kind of physical therapy will be required. Very little consideration is given to what is truly the most important component: mental and emotional recovery.

When an operation is performed the body undergoes a controlled injury. By surgically treating an injured joint, a physical toll is exacted. We, as surgeons, are very adept at explaining the average length of time it takes the joint to recover from surgery. We often neglect to talk with patients about the mental toll.

Studies that have focused on trauma patients (car accidents, falls, industrial accidents) have shown that the body often heals before the mind. The brain struggles to process the trauma, and the results can be sleep disturbance, depression, and mood swings. These experiences can be amplified by limited mobility and the side effects of narcotic pain medication. Though most of the studies focus on trauma patients, the lessons can be applied to patients undergoing elective surgery.

Patients undergoing elective orthopedic surgery have an advantage over trauma patients in that they have time to prepare, physically and mentally. They can make household accommodations, alert their employer of future absence, and arrange for a friend or family member to act as caregiver after surgery. Despite these preparations, however, the patient’s mental and emotional health is affected by surgery.

The most common complaint in this regard typically related to energy and mood. A patient no longer has the pain they were dealing with before surgery. Physical therapy is progressing well. Family members notice the patient is moving around better. Still, the patient may not register these positive outcomes.

“I just don’t have my energy, Doc.”

“I always feel like I need a nap.”

A family member may state, “He just seems really down, not himself.”

This is normal. Any surgery, no matter how minimally invasive, is still a trauma to the body and as such, must be processed by the mind. Patients should be reassured that this is a part of the normal healing process. Sleep is needed to help physical and mental recovery, and naps should be encouraged. Often patients and their family members just need the assurance that this is all part of the rehabilitative process. It is our responsibility as doctors to provide this support.