Fatigue, anxiety, and cognitive effects in neurosurgical patients: a prospective multicenter longitudinal study

Existing studies on postoperative fatigue (POF) following neurosurgery are generally small, retrospective, and lack longitudinal data. Despite frequent associations with temporary cognitive impairment and mood disorders, the precise relationship remains unclear. This study investigated POF following neurosurgery and its association with anxiety, depression, and cognitive impairment.

This prospective multicenter study enrolled patients undergoing elective or semi-elective cranial or spinal surgery at four centers. Assessments including the Fatigue Severity Scale (FSS), Christensen Fatigue Scale, visual analog scale for pain, Cognitive Failures Questionnaire (CFQ), and Hospital Anxiety and Depression Scale (HADS) were conducted preoperatively and 1 week, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Changes in scores over time were analyzed using random-effects models, while the relationship between FSS score and anxiety, depression, and CFQ scores was analyzed using linear regression. Baseline characteristics including antiepileptic drug use, Charlson Comorbidity Index, and complications were collected.

From 2017 to 2022, 247 patients were recruited, with 182 (92 cranial, 90 spinal) patients included in the final analysis. Overall, 59% of cranial surgery patients experienced fatigue at baseline, with an average increase in FSS score of 0.46 (95% CI -0.12 to 0.72, p = 0.01) at 1 week compared with preoperatively. The FSS score reverted to baseline at 6 weeks. Of spinal surgery patients, 68% reported fatigue at baseline. They had no significant increase in FSS score postoperatively but demonstrated improvement by 6 weeks, which was sustained up to 12 months. Preoperative fatigue and depression predicted increased POF. Cranial surgery patients had worse depression at 1 week postoperatively before returning to baseline at 6 weeks. Depression in spinal surgery patients did not worsen postoperatively but rather improved from 6 weeks to 12 months. Anxiety improved in both cohorts postoperatively. CFQ scores improved at 1 and 6 weeks and then returned to preoperative levels in both cohorts. Elevated HADS scores (≥ 8) correlated with a 6-point higher CFQ score. Postoperative pain significantly influenced POF, anxiety, and depression, with POF associated with anxiety, depression, and cognitive impairment.

Cranial surgery patients experienced transiently heightened POF at 1 week, reverting to baseline, while spinal surgery patients had improved POF from 6 weeks onward. Preoperative fatigue and depression predicted worse POF, which in turn was associated with increased anxiety, depression, and cognitive dysfunction. Postoperative pain also had a major influence on these symptoms.