Incidence and influencing factors of post-traumatic stress symptoms in patients after surgery for acute intestinal obstruction

Abstract

BACKGROUND

Acute intestinal obstruction (AIO) is an urgent surgical emergency characterized by a high physiological and psychological burden. Post-traumatic stress symptoms (PTSS) are now widely recognized as a common sequela of acute illness and emergency surgery in critically ill patients, with incidence rates of 20%-30% reported in intensive care unit populations; however, systematic studies of early postoperative PTSS following emergency abdominal surgery for AIO remain scarce. Risk factors for PTSS in this surgical population, including trauma severity, postoperative pain, complications, and social support, are not well characterized and warrant focused epidemiological investigation.

AIM

To explore the incidence and predictors of PTSS in patients with AIO after surgery.

METHODS

A total of 311 patients who underwent surgical treatment for AIO in the general surgery department of our hospital between January 2021 and July 2025 were enrolled. Clinical data were collected retrospectively from medical records; at three months postoperatively, psychological scales [Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C), Self-rating Anxiety Scale, Self-rating Depression Scale, Social Support Rating Scale, and World Health Organization Quality of Life Brief Version] were administered via outpatient interview or telephone follow-up as part of the routine post-discharge follow-up program. Demographic, disease- and surgery-related, perioperative pain, and postoperative data were collected. Univariate and multivariate logistic regression analyses were performed to identify factors influencing PTSS.

RESULTS

Of the 311 patients, 89 (28.6%) were diagnosed with PTSS (PCL-C score ≥ 38) and 37 (11.9%) had a PCL-C score ≥ 50. Multivariate logistic regression analysis demonstrated that strangulated intestinal obstruction [odds ratio (OR) = 2.348, 95% confidence interval (CI): 1.287-4.285; P = 0.005], open surgery (OR = 2.612, 95%CI: 1.426-4.785; P = 0.002), stoma formation (OR = 2.184, 95%CI: 1.156-4.125; P = 0.016), postoperative complications (OR = 2.876, 95%CI: 1.582-5.231; P = 0.001), and the 24-hour postoperative pain score during activity (OR = 1.386, 95%CI: 1.132-1.697; P = 0.002) were independent risk factors associated with PTSS. The area under the curve of the prediction model was 0.782 (95%CI: 0.728-0.836), with a sensitivity and specificity of 74.2%, and 75.7%, respectively.

CONCLUSION

The prevalence of PTSS in patients after surgery for AIO is 28.6%. Strangulated bowel obstruction, open surgery, stoma creation, postoperative complications, and postoperative pain are independently associated with PTSS. Clinical practice should focus on postoperative mental health monitoring, with provision for early and targeted interventions in high-risk patients.

Keywords: Acute intestinal obstruction; Post-traumatic stress symptoms; Risk factors; Logistic regression analysis

Core Tip: Post-traumatic stress symptoms occurred in 28.6% of patients following surgery for acute intestinal obstruction, with 11.9% meeting the criteria for probable post-traumatic stress disorder. Multivariate logistic regression identified five independent risk factors: Strangulated obstruction, open surgical approach, stoma formation, postoperative complications, and higher 24-hour postoperative pain scores during activity. A predictive model incorporating these factors achieved an area under the curve of 0.782, with a sensitivity and specificity of 74.2% and 75.7%, respectively. These findings highlight the substantial psychological burden of emergency bowel surgery and support routine postoperative mental health screening with early targeted interventions for high-risk patients to improve recovery outcomes.