Subclinical anxiety and depression and postoperative complications after major colorectal surgery: A 2-center study

The prevalence of anxiety and depression in patients with cancer and inflammatory bowel diseases is reported to be 25%-40% and 25%-30%, respectively, and has been associated with multiple postoperative complications in different surgery types.

This is an observational, prospective, and case-control study conducted at 2 referral centers. Adult patients undergoing elective colorectal surgery for colorectal cancer or inflammatory bowel disease completed the Hospital Anxiety and Depression Scale before surgery, and postoperative outcomes were registered. The primary objective was to identify risk factors of clinically relevant 90-day postoperative complications. Secondary objectives include length of hospital stay, postoperative pain, levels of C-reactive protein, time to first bowel movement, time to normal diet, and readmissions.

One hundred sixty-one patients were included in the study. Clinically relevant postoperative complications occurred in 41 patients (25%, "Complications group"), whereas in 120 patients (75%, "No complications group"), they did not. The risk factors of clinically relevant postoperative complications were inflammatory bowel disease (odds ratio, 2.07; 95% confidence interval, 0.93-4.62; P = .082), active smoking (odds ratio, 2.53; 95% confidence interval, 0.98-6.54; P = .062), low hemoglobin (mean difference, 0.93; 95% confidence interval, 0.22-1.64; P = .024), and high Hospital Anxiety and Depression Scale score (mean difference, -2.77; 95% confidence interval, -5.32 to -0.22; P = .021). At multivariable analysis, high hemoglobin was protective against postoperative complications (odds ratio, 0.81; 95% confidence interval, 0.67-0.97; P = .021), and high Hospital Anxiety and Depression Scale score was an independent risk factor of postoperative complications (odds ratio, 1.07; 95% confidence interval, 1.01-1.13; P = .024).

Patients with preoperative high Hospital Anxiety and Depression Scale scores had a higher risk of developing clinically relevant complications. Given the high prevalence of anxiety and depression reported in inflammatory bowel disease and colorectal cancer, perioperative psychological screening and interventions should be considered routinely.