Postoperative depression and anxiety in patients undergoing intestinal tumor surgery: Incidence, predictors, and impact on quality of life

Abstract

BACKGROUND Postoperative depression and anxiety among patients with intestinal tumor surgery are closely related to inflammation and nutritional imbalance, which in turn, can affect quality of life. AIM To systematically evaluate the occurrence regularity of depression and anxiety, predictive factors, and dynamic effects on the quality of life of patients after intestinal tumor surgery, to provide a basis for clinical psychological intervention. METHODS This prospective observational study included 120 patients who underwent intestinal tumor surgery. The Hamilton Depression Scale (HAMD-17) and Self-Rating Anxiety Scale (SAS) were applied on the 3rd, 7th, and 30th days after surgery to assess the psychological state, and the 36-Item Short-Form (SF-36) scale was used to assess the quality of life. The inflammation index [neutrophil-to-lymphocyte ratio (NLR) and albumin-to-fibrinogen ratio (AFR)] and nutrition index were measured simultaneously. Statistical analysis was performed using a mixed-effects model, intermediary analysis, and XGBoost algorithm. RESULTS In this study sample, the depression and anxiety scores decreased significantly with time (decreases from the 3rd to the 30th day were all P < 0.05), suggesting that the symptoms gradually improved. The NLR was significantly increased, and the AFR was significantly decreased after surgery (P < 0.05). The partial recovery of albumin and total lymphocyte count at 72 hours post-surgery continuously improved over time (on the 30th day compared with that on the 3rd day P < 0.05). The scores of each dimension of the SF-36 also increased significantly over time (both P < 0.05, on the 90th day compared with that on the 3rd day), while the physiological and social functions improved most significantly. In contrast, the overall complication rate decreased significantly over time (P < 0.05), with incisional infection and hemorrhage showing the most significant reduction. The analysis of the mixed effect model showed that time had significant negative/positive effects on the psychological state of patients (HAMD: β = -1.2, P < 0.05; SAS: β = -1.1, P < 0.05), inflammation (NLR: β = -0.85, P < 0.05) and quality of life (SF-36: β = 3.5, P < 0.05). The NLR and AFR played significant intermediary roles in the impact of psychological disorders on quality of life (indirect effect, P < 0.05). The XGBoost model identified hypotension during surgery, postoperative high NLR (> 7.0), and low AFR (< 12.0) as key predictors, with an area under the curve (AUC) of 0.873. The external validation AUC of the XGBoost model was 0.826 (95%CI: 0.775-0.877), with a critical value of 0.612, sensitivity of 78.3%, and specificity of 75.6%. These core predictive factors were consistent with those identified in the original study. CONCLUSION Psychological disorders after surgery for intestinal tumors are closely related to inflammation activation and nutritional imbalance, and are most significant in the early postoperative period. Intraoperative hypotension and postoperative NLR/AFR abnormalities are strong predictors of psychological risks. Inflammatory markers also play a key intermediary role in the impact of postoperative psychological disorders on quality of life. We recommend measuring NLR and AFR at 24 hours postoperatively, with intervention thresholds set at NLR > 7.0 and AFR < 12.0. Intraoperative blood pressure should be maintained above 90 mmHg to reduce psychological risks. Importantly, a physical and mental integration rehabilitation model should be implemented.