Enhancing perianal disease management with integrated physical and psychological approaches

Abstract

This article provides a comprehensive analysis of the study by Hou et al, focusing on the complex interplay between psychological and physical factors in the post-operative recovery (POR) of patients with perianal diseases. The study sheds light on how illness perception, anxiety, and depression significantly influence recovery outcomes. Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery. The article explores the critical role of pre-operative psychological assessment, highlighting the need for mental health support and personalized recovery plans in enhancing POR quality. A multidisciplinary approach, integrating mental health professionals with surgeons, anesthesiologists, and other specialists, is emphasized to ensure comprehensive care for patients. The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

Key Words: Perianal disease; Post-operative recovery; Anxiety; Depression; Pain management; Emotional well-being; Multidisciplinary approach

Core Tip: This article highlights the critical role of addressing both psychological and physical factors in post-operative recovery for perianal diseases, as evidenced by Hou et al’s study. Their findings show that pre-operative illness perception and emotional states significantly influence recovery outcomes. Effective strategies include integrating psychological assessments, comprehensive counseling, and a multidisciplinary care approach.

TO THE EDITOR

Perianal diseases, affecting the area around the anus, encompass diverse conditions, including inflammatory, infectious, and neoplastic disorders. These diseases, including hemorrhoids, perianal fistulas, abscesses, anal fissures, and perianal Crohn’s disease, often present with overlapping symptoms, such as pain, swelling, discharge, and bleeding. The related discomfort caused by these diseases is exacerbated during defecation, leading to significant physical and emotional distress that greatly impacts the patient’s quality of life[1-3]. While surgical intervention is an effective treatment modality for rapid symptom relief, the post-operative recovery (POR) phase is influenced by multiple factors beyond surgery itself. Physiological factors such as infection control, wound healing, recurrent abscesses, comorbidities, nutrition, bowel movement regulation and pain management are critical to recovery[4]. Equally important are psychological factors, which play a significant role in influencing recovery speed, likelihood of complications, and overall well-being of the patient.

The recent research by Hou et al[5], on the “Correlation linking illness perception, negative emotions, and the post-operative recovery effect in patients with perianal disease”, examined the impact of pre-operative illness perception, referring to a patient's disease knowledge or awareness, emotional states (anxiety and depression), and POR quality in 146 Chinese patients with perianal disease. The study findings provide valuable insights that can improve patient care strategies, stressing the need to integrate psychological assessments and interventions into routine surgical care for perianal diseases. In this article, we will analyze Hou et al’s study[5], explore the implications for patient management, and propose innovative strategies to enhance recovery outcomes through a holistic, multidisciplinary approach.

PSYCHOLOGICAL IMPACT ON POR IN PERIANAL DISEASE

Although the interplay between psychological factors and physical recovery in surgical patients is increasingly recognized, it remains underutilized in clinical practice. The study by Hou et al[5] takes an important step in addressing this gap by developing a predictive model to assess the impact of illness perception, anxiety, and depression on POR in perianal disease. The multiple linear regression model, constructed based on these factors, demonstrated a sensitivity of 83.33%, a specificity of 75.00%, and an overall accuracy of 80.00% in predicting recovery outcomes. The model is intended to help healthcare professionals identify patients who may experience difficulties during recovery, allowing for more tailored interventions to improve recovery quality. Their findings revealed that over one-third of patients had poor disease knowledge, and the vast majority exhibited signs of anxiety (67.8%) and depression (69.9%) before surgery. These emotional states can affect recovery by impairing physiological functions such as immune response, wound healing and pain management. Hence, incorporating mental health support and educational interventions into pre-operative planning could significantly improve recovery outcomes. While this model offers valuable insights, future improvements may involve more sophisticated predictive tools, such as machine learning or advanced statistical techniques, to account for additional variables, including biomarkers of stress, genetic predispositions, and real-time monitoring of physiological responses through wearable technology. This approach could pave the way for personalized recovery pathways that adapt to the unique psychological and physiological profile of each patient.

LINKING ILLNESS PERCEPTION, EMOTIONAL FACTORS AND POR

The study by Hou et al[5] challenges the traditional notion that POR is primarily driven by physical factors. Their findings emphasize the critical role of psychological preparedness in improving recovery outcomes. Specifically, higher pre-operative illness perception scores correlate with fewer emotional disturbances and better overall recovery, as measured by the 15-item postoperative quality of recovery (QoR-15) score[6]. The average QoR-15 score for patients with perianal disease was 96.77 ± 9.85, with sub-scores reflecting key recovery aspects, such as physical comfort, mental support, and emotional well-being.

Demographic and clinical factors, including age and disease duration, also significantly influenced these outcomes, with older patients and those with prolonged disease histories demonstrating lower recovery scores[5]. Regression analysis showed that illness perception, anxiety, depression, age, and disease duration together accounted for 72.3% of the variance in POR outcomes. These findings emphasize the multifaceted nature of recovery, showing that psychological and emotional factors are just as important as physical healing in determining post-surgical success. This highlights the importance of integrating comprehensive educational sessions that prepare patients both physically and mentally for surgery.

However, merely providing information is insufficient. Healthcare providers can adopt a more integrated, multidisciplinary approach that addresses the unique psychological needs of each patient. Tailored interventions, such as cognitive-behavioral therapy, mindfulness-based stress reduction, and relaxation techniques, should be routinely offered, particularly to high-risk patients with low illness perception or high levels of anxiety and depression. These interventions, delivered by trained mental health professionals within the surgical team, can significantly strengthen the patient’s resilience and improve both emotional and physical recovery outcomes.

THE ROLE OF MULTIDISCIPLINARY CARE IN PATIENTS’ HOLISTIC RECOVERY

A successful recovery from perianal surgery necessitates a coordinated approach across multiple specialties. The study by Hou et al[5] reinforces the need for a multidisciplinary team that includes not only surgeons and anesthesiologists but also mental health professionals, physical therapists, nutritionists, and geriatric specialists. This integrated model of care would enable personalized recovery plans that address both physical and psychological aspects of healing.

Anesthesiology and pain management

Anesthesiologists play a key role in managing both pre-operative anxiety and post-operative pain. Incorporating relaxation techniques before anesthesia and using multimodal pain management strategies (utilizing medications from different drug classes to manage pain effectively, with the aim of minimizing or eliminating opioid dependence) can reduce stress, improve pain control, and accelerate recovery. Using music is a safe and cost-effective approach to improving patient outcomes in anesthesia settings. Research has demonstrated that music therapy can reduce preoperative anxiety, enhance patient experiences, and aid in recovery[7,8]. During regional anesthesia, music interventions could lower anxiety and foster inner peace[9]. In patients under general anesthesia, music therapy has been associated with reduced pain, decreased opioid use, and higher patient satisfaction. Notably, allowing patients to choose their own music further enhances the effectiveness of the intervention[9].

Nursing and post-operative care

Nurses, who are often the first point of contact for patients, are uniquely positioned to provide continuous emotional support during the perioperative period. Training nursing staff to recognize signs of anxiety and depression, as well as implementing routine screening tools such as the hospital anxiety and depression scale (HADS), can ensure timely psychological interventions[10]. Nursing care plans should be holistic, focusing on both wound care and emotional well-being to enhance the overall quality of recovery.

Gastroenterology

Perianal diseases are often accompanied by underlying gastrointestinal conditions such as inflammatory bowel disease (IBD). Gastroenterologists are critical in managing these comorbidities pre- and postoperatively, ensuring that conditions such as IBD or chronic constipation do not interfere with recovery. Dietary management, including fiber supplementation and medication adjustments, can aid in preventing recurrence and complications.

Geriatrics

Age is a significant factor influencing POR, due to slower wound healing, weakened immunity, and a higher prevalence of comorbidities in older patients. Geriatric specialists should work closely with surgeons to develop tailored recovery plans that include not only physical rehabilitation but also nutritional and social support. Considering the association between age and prolonged recovery, addressing the specific vulnerabilities of elderly patients will be essential to improving outcomes.

Physical therapy

Physical independence post-surgery plays a crucial role in recovery, particularly for elderly patients. Early mobilization helps reduce complications (e.g., thrombosis) and promotes faster recovery. Physical therapists can provide tailored rehabilitation plans, including pelvic floor exercises and strengthening activities.

CLINICAL RECOMMENDATIONS

Given the strong association between illness perception, psychological factors, and recovery outcomes, a multidisciplinary, patient-centered approach is essential. Therefore, we propose the following clinical recommendations:

Comprehensive pre-operative counseling

Healthcare providers should implement structured educational programs tailored to each patient’s level of understanding and psychological readiness. These programs should include information on disease processes, expected surgical outcomes, and recovery timelines while also addressing emotional concerns.

Psychological screening and personalized recovery pathways

Routine psychological assessment tools, such as HADS, should continue to be integrated into pre-operative evaluations, with timely interventions offered to patients at risk of complications. However, more innovative approaches, including artificial intelligence-driven predictive models and real-time digital interventions that incorporate both physiological and psychological data, are needed to create personalized recovery pathways. These advanced strategies can enhance scalability and ensure targeted support for patients at higher risk of poor outcomes.

CONCLUSION

This article highlights the growing recognition of the interplay between psychological and physical factors in POR. The study by Hou et al[5] provides compelling evidence that enhancing illness perception and addressing negative emotional states can significantly improve recovery outcomes in patients with perianal disease. However, healthcare systems must shift toward a more integrated, multidisciplinary model of care that addresses the psychological, physical, and social dimensions of recovery to fully realize the potential of the aforementioned findings. By adopting innovative, patient-centered strategies that prioritize mental health and personalized care, we can not only improve the immediate post-operative experience but also ensure long-term well-being and quality of life for patients recovering from surgery for perianal diseases. This approach represents a paradigm shift in surgical recovery, one that could dramatically enhance outcomes and reduce healthcare costs through more effective, holistic patient management.