Sage Journals: Discover world-class research

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.

Keywords

postoperative complications depression anxiety database mining healthcare utilization propensity score matching

Get full access to this article

View all access options for this article.

References

Ghoneim

O’Hara

. Depression and postoperative complications: an overview. BMC Surg. 2016;16:5.

Lin

Zhang

Xiao

Mei

. The impact of depression and anxiety disorders on postoperative outcomes for patients having total hip or knee arthroplasty: protocol of a meta-analytic study from cohort studies. PLoS One. 2025;20(1):e0318067.

Zhou

Wang

Gao

Yang

. Early-stage postoperative depression and anxiety following orthognathic surgery: a cross-sectional study. BMC Anesthesiol. 2024;24(1):338.

Bufalino

Hepgul

Aguglia

Pariante

. The role of immune genes in the association between depression and inflammation: a review of recent clinical studies. Brain Behav Immun. 2013;31:31-47.

Kaster

Gadotti

Calixto

Santos

Rodrigues

. Depressive-like behavior induced by tumor necrosis factor-α in mice. Neuropharmacology. 2012;62(1):419-426.

Miller

Raison

. The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 2016;16(1):22-34.

Dantzer

O’Connor

Freund

Johnson

Kelley

. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9(1):46-56.

Capuron

Miller

. Immune system to brain signaling: neuro psycho pharmacological implications. Pharmacol Therapeut. 2011;130(2):226-238.

Pariante

Lightman

. The HPA axis in major depression: classical theories and new developments. Trends Neurosci. 2008;31(9):464-468.

10.

O’Gara

Espinosa Leon

Robinson

Schaefer

Talmor

Fischer

. New onset postoperative depression after major surgery: an analysis from a national claims database. BJA open. 2023;8:100223.

11.

Khalil

Woldesenbet

Thammachack

, et al. Association of mental health assessment with postoperative outcomes following major surgery in older individuals. Surgery. 2025;180:109046.

12.

Tsaousi

Logan

Bilotta

. Postoperative pain control following craniotomy: a systematic review of recent clinical literature. Pain Pract: The Official Journal of the World Institute of Pain. 2017;17(7):968-981.

13.

Kudoh

Takase

Katagai

Takazawa

. Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion. Neuroimmunomodulation. 2005;12(1):60-66.

14.

Raison

Capuron

Miller

. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24-31.

15.

Schneeweiss

Avorn

. A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol. 2005;58(4):323-337.

16.

Hashimoto

Brodt

Skelly

Dettori

. Administrative database studies: goldmine or goose chase? Evid Base Spine Care J. 2014;5(2):74-76.

17.

Waldron

Nunn

Mac Giolla Phadraig

, et al. Oral hygiene interventions for people with intellectual disabilities. Cochrane Database Syst Rev. 2019;5(5):Cd012628.

18.

Taira

Seto

Siegrist

Cosgrove

Berezin

Cohen

. Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials. Am Heart J. 2003;145(3):452-458.

19.

Draper

Smith

. Applied Regression Analysis. 3rd ed. Applied Regression Analysis; 2014.

20.

Austin

. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46(3):399-424.

21.

Rubin

. Multiple Imputation for Nonresponse in Surveys: Multiple Imputation for Nonresponse in Surveys. Wiley-Interscience; 2008.

22.

von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet (London, England). 2007;370(9596):1453-1457.

23.

Benchimol

Smeeth

Guttmann

, et al. The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med. 2015;12(10):e1001885.

24.

Copeland

Zeber

Pugh

Mortensen

Restrepo

Lawrence

. Postoperative complications in the seriously mentally ill: a systematic review of the literature. Ann Surg. 2008;248(1):31-38.

25.

Vochteloo

Moerman

Tuinebreijer

, et al. More than half of hip fracture patients do not regain mobility in the first postoperative year. Geriatr Gerontol Int. 2013;13(2):334-341.

26.

Tracey

. The inflammatory reflex. Nature. 2002;420(6917):853-859.

27.

Wright

Strike

Brydon

Steptoe

. Acute inflammation and negative mood: mediation by cytokine activation. Brain Behav Immun. 2005;19(4):345-350.

28.

Broadbent

Petrie

Alley

Booth

. Psychological stress impairs early wound repair following surgery. Psychosom Med. 2003;65(5):865-869.

29.

Weiser

Gawande

. Excess surgical mortality: strategies for improving quality of care. In: Debas

Donkor

Gawande

Jamison

Kruk

Mock

, eds. Essential Surgery: Disease Control Priorities. (3rd ed.). The International Bank for Reconstruction and Development / The World Bank© 2015 International Bank for Reconstruction and Development / The World Bank; 2015.

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

Abstract

Objective

Methods

Results

Conclusions

Keywords

Get full access to this article

References