Anxiety as a risk factor for postoperative complications after colorectal surgery: new area for perioperative optimization

The effect of preoperative anxiety and depression on postoperative complications has recently been explored in different surgical settings, including cardiac and orthopaedic surgery1–5, with mixed results owing to the high level of heterogeneity of the psychological assessment tools and outcome definitions1,4,5. The evidence for colorectal surgery is limited and indirect6. The authors conducted a pilot study of 65 patients undergoing colorectal resection for colorectal cancer (35 patients) or inflammatory bowel disease (IBD) (30) to assess the relationship between anxiety, depression, stress, and postoperative outcomes using validated assessment tools. Patients scheduled for elective colorectal resection were assessed before surgery for stress, anxiety, and depression using the Hospital Anxiety and Depression Scale (HADS)7 and the Perceived Stress Scale (PSS)8. Patients with recurrent disease, metastatic cancer, or established psychiatric disorders were excluded. Thirty-day postoperative complications, defined as those with a Clavien–Dindo grade of II or higher9, were registered. Variables with P ≤ 0.100 in univariable analysis were included in a regression model to ascertain the effect of preoperative variables on postoperative complications. Linear and multiple regression analyses were conducted to explore the correlation between anxiety and other variables. A detailed description of the methods is reported in Supplementary material.