The effect of depression comorbid with alcohol use disorder on postoperative morbidity of patients undergoing resection of upper gastrointestinal and pancreatic tumors: a study based on a national inpatient sample

Patients undergoing resection of upper gastrointestinal and pancreatic tumors are at considerable risk for postoperative morbidity. The co-occurrence of alcohol use disorder (AUD) and depression may synergistically impair recovery. This study aimed to investigate the effect of depression comorbid with alcohol use disorder (Dep-AUD) on postoperative morbidity of patients undergoing resection of upper gastrointestinal and pancreatic tumors. Data from the National Inpatient Sample (2010–2019) were analyzed. Patients undergoing resection of upper gastrointestinal and pancreatic tumors were identified using ICD codes, and divided into Dep-AUD, Non-Dep-AUD, depression, and AUD groups. Multivariable logistic regression was used to investigate the effect of Dep-AUD, Non-Dep-AUD, depression, and AUD on postoperative morbidity. Among 60,783 patients, 637 (1.05%) had Dep-AUD. After covariate adjustment, Dep-AUD was independently associated with increased risks of delirium (aOR 2.27), wound dehiscence (aOR 2.16), and invasive respiratory support (aOR 1.47), alongside the longest median stays and highest costs. A significant supra-additive interaction was observed for wound dehiscence, particularly in esophagectomy and gastrectomy. For other complications like delirium, the elevated risk primarily reflected the additive accumulation of independent effects rather than true biological synergy. Dep-AUD significantly exacerbates postoperative complications — notably wound dehiscence, delirium, and respiratory failure — and increases resource utilization after upper gastrointestinal and pancreatic resections. These procedure-specific findings emphasize the urgent need for systematic preoperative screening and tailored multidisciplinary optimization strategies to mitigate surgical risks in this vulnerable population.