Depression, anxiety and PTSD symptoms in patients following emergency surgery: A systematic review and meta-analysis

Emergency surgery represents a major stressor that may increase the risk of adverse mental health outcomes. This systematic review and meta-analysis aimed to assess the incidence of clinically significant symptoms of depression, anxiety and PTSD after emergency surgery and the associated risk factors. Medline, EMBASE and PsycInfo were searched on February 17th 2025 for randomized trials and observational studies including patients ≥ 18 years undergoing emergency surgery. Trauma, obstetric and transplantation surgery were excluded. Three reviewers independently selected studies. Bias was assessed using the JBI Checklist for Prevalence Studies. Symptom incidences of symptoms of depression and PTSD were pooled in a random effects model. The certainty of the evidence was assessed using GRADE. 11 studies with 1,144 patients were included. The pooled incidence of depressive symptoms was 30% (95% confidence interval (CI) = 11–60%; I 2 = 86.5%, prediction interval (PI) = 3–85%), and PTSD symptoms 24% (95% confidence interval (CI) = 17–35%; I 2 = 59.5%, prediction interval (PI) = 12–44%). Data on anxiety were limited and inconsistent. Individually identified risk factors included reduced mobility, co-existing depressive symptoms, lower education in males, and lower household income for PTSD, and lower premorbid mobility and a history of treated depression for depression. Emergency surgery is associated with increased risk of postoperative symptoms of depression and PTSD. Evidence on anxiety is limited. These findings underscore symptoms of depression and PTSD as an overlooked complication warranting further studies.