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

Table 1 Comparison of general data between the two groups, n (%)

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	Test statistic	P value
Gender			χ2 = 0.312	0.576
Male	52 (58.4)	120 (54.1)
Female	37 (41.6)	102 (45.9)
Age (years, mean ± SD)	59.8 ± 13.6	57.8 ± 14.4	t = 1.134	0.258
BMI (kg/m2, mean ± SD)	23.2 ± 3.4	23.6 ± 3.2	t = -0.976	0.33
Education level			χ2 = 7.692	0.021
Junior high school and below	58 (65.2)	115 (51.8)
High school/vocational school	21 (23.6)	68 (30.6)
College and above	10 (11.2)	39 (17.6)
Marital status			χ2 = 2.148	0.143
Married	74 (83.1)	198 (89.2)
Unmarried/divorced/widowed	15 (16.9)	24 (10.8)

PTSS: Post-traumatic stress symptoms; BMI: Body mass index.

Table 2 Comparison of disease- and surgery-related data between the two groups, n (%)

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	Test statistic	P value
Etiology of intestinal obstruction			χ2 = 4.216	0.239
Adhesive	42 (47.2)	128 (57.7)
Incarcerated hernia	28 (31.5)	58 (26.1)
Neoplastic	14 (15.7)	26 (11.7)
Other	5 (5.6)	10 (4.5)
Obstruction site			χ2 = 2.487	0.288
High small intestine	23 (25.8)	48 (21.6)
Low small intestine	38 (42.7)	112 (50.5)
Colon	28 (31.5)	62 (27.9)
Obstruction type			χ2 = 8.924	0.003
Simple	51 (57.3)	168 (75.7)
Strangulated	38 (42.7)	54 (24.3)
Time from onset to surgery [hours, median (P25, P75)]	18 (12, 28)	14 (10, 22)	Z = -2.513	0.012
Surgical approach			χ2 = 18.647	< 0.001
Laparoscopic	24 (27.0)	126 (56.8)
Open	65 (73.0)	96 (43.2)
Surgical duration [minutes, median (P25, P75)]	165 (125, 215)	140 (105, 185)	Z = -2.748	0.006
Intraoperative blood loss [mL, median (P25, P75)]	120 (80, 200)	100 (60, 150)	Z = -2.437	0.015
Intestinal resection			χ2 = 11.324	0.001
Yes	46 (51.7)	74 (33.3)
No	43 (48.3)	148 (66.7)
Stoma			χ2 = 22.186	< 0.001
Yes	35 (39.3)	38 (17.1)
No	54 (60.7)	184 (82.9)

PTSS: Post-traumatic stress symptoms.

Table 3 Comparison of postoperative data between the two groups, n (%)

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	Test statistic	P value
Postoperative complications			χ2 = 21.438	< 0.001
Yes	42 (47.2)	52 (23.4)
No	47 (52.8)	170 (76.6)
Complication type1
Pulmonary infection	18 (20.2)	22 (9.9)
Incision infection	12 (13.5)	15 (6.8)
Abdominal infection	8 (9.0)	10 (4.5)
Anastomotic leakage	6 (6.7)	4 (1.8)
Intestinal fistula	5 (5.6)	3 (1.4)
Other	3 (3.4)	8 (3.6)
Repeat surgery			χ2 = 9.876	0.002
Yes	16 (18.0)	15 (6.8)
No	73 (82.0)	207 (93.2)

¹Some patients had multiple complications.

PTSS: Post-traumatic stress symptoms.

Table 4 Comparison of perioperative pain scores between the two groups [median (P25, P75)]

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	Z value	P value
24-hour postoperative pain at rest	6 (5, 7)	5 (4, 6)	-5.824	< 0.001
24-hour postoperative pain during activity	7 (6, 8)	6 (5, 7)	-6.147	< 0.001
48-hour postoperative pain at rest	5 (4, 6)	4 (3, 5)	-5.392	< 0.001
48-hour postoperative pain during activity	6 (5, 7)	5 (4, 6)	-5.678	< 0.001
72-hour postoperative pain at rest	4 (3, 5)	3 (2, 4)	-5.156	< 0.001
72-hour postoperative pain during activity	5 (4, 6)	4 (3, 5)	-5.431	< 0.001

PTSS: Post-traumatic stress symptoms.

Table 5 Comparison of psychological state, social support, and quality of life between two the groups (mean ± SD)

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	t value	P value
PCL-C total score	46.8 ± 7.2	28.3 ± 5.6	23.564	< 0.001
Re-experiencing symptoms	15.2 ± 3.1	8.4 ± 2.2	20.318	< 0.001
Avoidance/numbing symptoms	18.6 ± 3.8	11.2 ± 2.8	18.127	< 0.001
Hyperarousal symptoms	13.0 ± 2.6	8.7 ± 2.1	14.832	< 0.001
SAS score	58.4 ± 8.6	42.3 ± 7.2	16.547	< 0.001
SDS score	60.2 ± 9.4	44.1 ± 8.3	15.126	< 0.001
SSRS total score	32.8 ± 6.4	40.5 ± 7.1	-9.187	< 0.001
Objective support	7.2 ± 2.1	9.4 ± 2.3	-8.124	< 0.001
Subjective support	16.3 ± 3.4	20.6 ± 3.8	-9.648	< 0.001
Support utilization	9.3 ± 2.2	10.5 ± 2.1	-4.562	< 0.001
WHOQOL-BREF
Physical domain	52.3 ± 10.2	68.4 ± 9.6	-13.572	< 0.001
Psychological domain	48.6 ± 11.4	65.2 ± 10.8	-12.481	< 0.001
Social relationships domain	54.7 ± 12.3	67.9 ± 11.2	-9.328	< 0.001
Environment domain	50.8 ± 10.6	64.3 ± 9.8	-11.024	< 0.001

PTSS: Post-traumatic stress symptoms; PCL-C: Post-Traumatic Stress Disorder Checklist-Civilian Version; SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale; SSRS: Social Support Rating Scale; WHOQOL-BREF: World Health Organization Quality of Life Brief Version.

Table 6 Comparison of anxiety and depression severity grades between the two groups, n (%)

Item	PTSS-positive group (n = 89)	PTSS-negative group (n = 222)	Test statistic	P value
Anxiety level			χ2 = 82.147	< 0.001
Normal (< 50 points)	12 (13.5)	152 (68.5)
Mild (50-59 points)	38 (42.7)	58 (26.1)
Moderate (60-69 points)	31 (34.8)	11 (5.0)
Severe (≥ 70 points)	8 (9.0)	1 (0.5)
Depression level			χ2 = 91.364	< 0.001
Normal (< 53 points)	8 (9.0)	138 (62.2)
Mild (53-62 points)	42 (47.2)	72 (32.4)
Moderate (63-72 points)	32 (36.0)	11 (5.0)
Severe (≥ 73 points)	7 (7.9)	1 (0.5)

PTSS: Post-traumatic stress symptoms.

Table 7 Univariate logistic regression analysis of influencing factors of post-traumatic stress symptoms

Variable	Coding	β	SE	Wald χ2	P value	OR	95%CI
Gender	Male = 0, female = 1	0.179	0.236	0.575	0.448	1.196	0.752-1.903
Age	Continuous variable	0.01	0.009	1.284	0.257	1.01	0.993-1.028
BMI	Continuous variable	-0.038	0.039	0.952	0.329	0.963	0.892-1.039
Education level	Junior high and below = 1, high school/vocational = 2, college and above = 3	-0.385	0.174	4.897	0.027	0.68	0.484-0.956
Marital status	Married = 0, unmarried/divorced/widowed = 1	0.506	0.347	2.126	0.145	1.659	0.840-3.277
Etiology of intestinal obstruction	Adhesive = 1, incarcerated hernia = 2, neoplastic = 3, other = 4	0.126	0.123	1.051	0.305	1.134	0.891-1.443
Obstruction site	High small intestine = 1, low small intestine = 2, colon = 3	0.145	0.127	1.303	0.254	1.156	0.901-1.483
Obstruction type	Simple = 0, strangulated = 1	0.849	0.296	8.227	0.004	2.337	1.308-4.176
Time from onset to surgery	Continuous variable	0.018	0.008	5.624	0.018	1.018	1.003-1.034
Surgical approach	Laparoscopic = 0, open = 1	1.234	0.287	18.473	< 0.001	3.435	1.958-6.027
Surgical duration	Continuous variable	0.005	0.002	6.854	0.009	1.005	1.001-1.009
Intraoperative blood loss	Continuous variable	0.003	0.001	5.342	0.021	1.003	1.000-1.005
Intestinal resection	No = 0, yes = 1	0.768	0.254	9.154	0.002	2.155	1.310-3.547
Stoma	No = 0, yes = 1	1.082	0.279	15.047	< 0.001	2.95	1.709-5.094
Postoperative complications	No = 0, yes = 1	1.082	0.262	17.049	< 0.001	2.95	1.766-4.929
Repeat surgery	No = 0, yes = 1	0.969	0.326	8.83	0.003	2.635	1.392-4.989
24-hour postoperative pain during activity	Continuous variable	0.412	0.098	17.632	< 0.001	1.51	1.246-1.830

BMI: Body mass index; OR: Odds ratio; CI: Confidence interval.

Table 8 Multivariate logistic regression analysis of influencing factors of post-traumatic stress symptoms

Variable	β	SE	Wald χ2	P value	OR	95%CI
Obstruction type (strangulated vs simple)	0.854	0.307	7.741	0.005	2.348	1.287-4.285
Surgical approach (open vs laparoscopic)	0.96	0.31	9.587	0.002	2.612	1.426-4.785
Stoma (yes vs no)	0.781	0.324	5.806	0.016	2.184	1.156-4.125
Postoperative complications (yes vs no)	1.057	0.307	11.862	0.001	2.876	1.582-5.231
24-hour postoperative pain during activity	0.326	0.104	9.847	0.002	1.386	1.132-1.697
Constant	-2.486	0.245	102.976	< 0.001	0.083

Model χ² = 78.563, P < 0.001; Hosmer-Lemeshow test χ² = 7.142, P = 0.521; Nagelkerke R² = 0.318. OR: Odds ratio; CI: Confidence interval.

Table 9 Receiver operating characteristic curve analysis of the prediction model

Item	AUC	95%CI	P value	Optimal cutoff value	Sensitivity (%)	Specificity (%)
Prediction model	0.782	0.728-0.836	< 0.001	0.298	74.2	75.7

AUC: Area under the curve; CI: Confidence interval.