Exploring the Relationship Between Surgical Outcomes and Psychiatric Disorders: A Database Mining Study on Postoperative Depression and Anxiety

Abstract

Objective

This study used population-scale administrative data to quantify the frequency, risk factors, and healthcare utilization implications of postoperative depression and anxiety.

Methods

A retrospective cohort analysis was conducted using the U.S. Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database from 2016 to 2022, encompassing 4.2 million surgical procedures across 47 states. Newly coded postoperative psychiatric disorders were identified using ICD-10 diagnostic codes (F32. x for depression and F41.x for anxiety) within 30 days post-surgery. Multivariable logistic regression and propensity score matching (1:1 nearest neighbor, caliper width 0.2σ) were employed to evaluate associations between surgical characteristics and psychiatric outcomes, adjusting for demographics, comorbidities, and institutional factors.

Results

The overall frequency of newly coded postoperative psychiatric disorders was 14.3%, including depression (9.1%), anxiety (8.7%), and mixed presentations (3.5%). Hip fracture surgery demonstrated the highest adjusted odds ratio (aOR 2.34, 95% CI = 2.18-2.51), followed by thoracotomy (aOR 1.89, 95% CI = 1.76-2.03) and cardiac procedures (aOR 1.67, 95% CI = 1.58-1.76). Significant associated factors included female sex (aOR 1.43, 95% CI = 1.39-1.47), age >65 years (aOR 1.28, 95% CI = 1.23-1.33), and operative duration exceeding 5 hours (aOR 1.52, 95% CI = 1.47-1.57). Propensity-matched analysis revealed substantial healthcare utilization disparities, including prolonged hospitalization (13.2 vs 8.4 days, P < 0.001), higher 30-day readmission rates (28.9% vs 19.6%, P < 0.001), and increased total costs ($47,680 vs $31,250, P < 0.001).

Conclusions

This comprehensive population-based analysis demonstrated substantial heterogeneity in the risk of postoperative psychiatric disorders across surgical specialties, with profound implications for healthcare utilization. These findings support the implementation of systematic psychiatric screening protocols and targeted perioperative interventions for high-risk surgical populations.