Published online Dec 21, 2025. doi: 10.3748/wjg.v31.i47.111599
Revised: September 8, 2025
Accepted: November 7, 2025
Published online: December 21, 2025
Processing time: 140 Days and 3.3 Hours
Postoperative depression and anxiety among patients with intestinal tumor surgery are closely related to inflammation and nutritional imbalance, which in turn, can affect quality of life.
To systematically evaluate the occurrence regularity of depression and anxiety, predictive factors, and dynamic effects on the quality of life of patients after intestinal tumor surgery, to provide a basis for clinical psychological intervention.
This prospective observational study included 120 patients who underwent intes
In this study sample, the depression and anxiety scores decreased significantly with time (decreases from the 3rd to the 30th day were all P < 0.05), suggesting that the symptoms gradually improved. The NLR was significantly increased, and the AFR was significantly decreased after surgery (P < 0.05). The partial recovery of albumin and total lymphocyte count at 72 hours post-surgery continuously improved over time (on the 30th day compared with that on the 3rd day P < 0.05). The scores of each dimension of the SF-36 also increased significantly over time (both P < 0.05, on the 90th day compared with that on the 3rd day), while the physiological and social functions improved most significantly. In contrast, the overall complication rate decreased significantly over time (P < 0.05), with incisional infection and hemorrhage showing the most significant reduction. The analysis of the mixed effect model showed that time had significant negative/positive effects on the psychological state of patients (HAMD: β = -1.2, P < 0.05; SAS: β = -1.1, P < 0.05), inflammation (NLR: β = -0.85, P < 0.05) and quality of life (SF-36: β = 3.5, P < 0.05). The NLR and AFR played significant intermediary roles in the impact of psychological disorders on quality of life (indirect effect, P < 0.05). The XGBoost model identified hypotension during surgery, postoperative high NLR (> 7.0), and low AFR (< 12.0) as key predictors, with an area under the curve (AUC) of 0.873. The external validation AUC of the XGBoost model was 0.826 (95%CI: 0.775-0.877), with a critical value of 0.612, sensitivity of 78.3%, and specificity of 75.6%. These core predictive factors were consistent with those identified in the original study.
Psychological disorders after surgery for intestinal tumors are closely related to inflammation activation and nutritional imbalance, and are most significant in the early postoperative period. Intraoperative hypotension and postoperative NLR/AFR abnormalities are strong predictors of psychological risks. Inflammatory markers also play a key intermediary role in the impact of postoperative psychological disorders on quality of life. We recommend measuring NLR and AFR at 24 hours postoperatively, with intervention thresholds set at NLR > 7.0 and AFR < 12.0. Intraoperative blood pressure should be maintained above 90 mmHg to reduce psychological risks. Importantly, a physical and mental integration rehabilitation model should be implemented.
Core Tip: Postoperative depression and anxiety are frequent but often overlooked in patients undergoing intestinal tumor surgery. This prospective observational study systematically evaluated the incidence, predictors, and impact on quality of life. Dynamic monitoring showed that psychological symptoms improved over time but were closely linked with inflammatory activation and nutritional imbalance. Intraoperative hypotension, high neutrophil-to-lymphocyte ratio, and low albumin-to-fibrinogen ratio emerged as strong predictors of adverse outcomes. These findings highlight the importance of early monitoring and integrated physical-psychological rehabilitation strategies to optimize recovery and long-term prognosis in intestinal tumor surgery patients.