Effect of perioperative psychological nursing on anxiety, depression, and recovery in colorectal cancer surgery: A prospective study

Table 1 Baseline demographic and clinical characteristics of study participants, n (%)

Characteristic	Intervention group (n = 75)	Control group (n = 75)	P value
Age (years), mean ± SD	61.4 ± 10.8	62.1 ± 11.3	0.696
Male	43 (57.3)	41 (54.7)	0.743
BMI (kg/m2), mean ± SD	24.3 ± 3.2	24.7 ± 3.5	0.468
Tumor location			0.812
Colon	41 (54.7)	42 (56.0)
Rectum	34 (45.3)	33 (44.0)
Tumor stage			0.891
Stage I	18 (24.0)	16 (21.3)
Stage II	28 (37.3)	30 (40.0)
Stage III	29 (38.7)	29 (38.7)
ASA classification			0.745
ASA I	21 (28.0)	19 (25.3)
ASA II	42 (56.0)	44 (58.7)
ASA III	12 (16.0)	12 (16.0)
Surgical approach			0.693
Laparoscopic	53 (70.7)	51 (68.0)
Open	22 (29.3)	24 (32.0)
Comorbidities
Hypertension	28 (37.3)	31 (41.3)	0.619

P values were calculated using independent t-tests for continuous variables and χ² tests for categorical variables. BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Anxiety and depression scores at different time points, mean ± SD

Time point	Intervention group	Control group	Mean difference (95%CI)	P value	Effect size (Cohen’s d)
HADS-A scores
Baseline	9.2 ± 3.1	9.4 ± 3.3	-0.2 (-1.2 to 0.8)	0.695	0.06
Postoperative day 3	6.1 ± 2.4a	9.8 ± 3.2	-3.7 (-4.7 to -2.7)	< 0.001	1.32
Postoperative day 7	5.2 ± 2.1a	9.1 ± 3.0	-3.9 (-4.8 to -3.0)	< 0.001	1.51
HADS-D scores
Baseline	8.3 ± 2.9	8.5 ± 3.0	-0.2 (-1.2 to 0.8)	0.677	0.07
Postoperative day 3	5.7 ± 2.2b	8.9 ± 2.8	-3.2 (-4.1 to -2.3)	< 0.001	1.27
Postoperative day 7	4.8 ± 1.9b	8.3 ± 2.7	-3.5 (-4.3 to -2.7)	< 0.001	1.48

^aP < 0.05 vs baseline (preoperative assessment) within the intervention group.

^bP < 0.001 vs baseline (preoperative assessment) within the intervention group.

Baseline refers to the preoperative assessment conducted 3-5 days before surgery. CI: Confidence interval; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale; HADS-D: Hospital Anxiety and Depression Scale-Depression subscale.

Table 3 Proportion of patients with clinically significant anxiety and depression, n (%)

Category	Intervention group (n = 71)	Control group (n = 70)	OR (95%CI)	P value
Anxiety (HADS-A ≥ 8)
Baseline	51 (71.8)	52 (74.3)	0.88 (0.41-1.89)	0.745
Postoperative day 3	21 (29.6)	56 (80.0)	0.10 (0.05-0.22)	< 0.001
Postoperative day 7	13 (18.3)	47 (67.1)	0.11 (0.05-0.24)	< 0.001
Depression (HADS-D ≥ 8)
Baseline	48 (67.6)	50 (71.4)	0.84 (0.40-1.75)	0.636
Postoperative day 3	16 (22.5)	52 (74.3)	0.10 (0.05-0.21)	< 0.001
Postoperative day 7	10 (14.1)	43 (61.4)	0.10 (0.04-0.22)	< 0.001

OR: Odds ratio; CI: Confidence interval; HADS-A: Hospital Anxiety and Depression Scale-Anxiety subscale (score ≥ 8 indicates clinically significant anxiety); HADS-D: Hospital Anxiety and Depression Scale-Depression subscale (score ≥ 8 indicates clinically significant depression).

Table 4 Postoperative pain scores and analgesic consumption, mean ± SD

Parameter	Intervention group	Control group	P value
NRS pain score at rest
24 hours	3.2 ± 1.1	4.5 ± 1.4	< 0.001
48 hours	2.8 ± 1.0	4.1 ± 1.3	< 0.001
72 hours	2.3 ± 0.9	3.6 ± 1.2	< 0.001
NRS pain score during movement
24 hours	4.8 ± 1.3	6.3 ± 1.6	< 0.001
48 hours	4.2 ± 1.2	5.8 ± 1.5	< 0.001
72 hours	3.6 ± 1.1	5.1 ± 1.4	< 0.001
Total opioid consumption (mg morphine equivalent)	45.3 ± 18.2	63.7 ± 24.5	< 0.001
Breakthrough analgesia doses	2.8 ± 1.6	4.5 ± 2.1	< 0.001
Pain interference with activity (0-10 scale)	3.9 ± 1.5	5.7 ± 1.8	< 0.001
Pain interference with sleep (0-10 scale)	3.4 ± 1.4	5.2 ± 1.7	< 0.001

P values were calculated using independent t-tests. NRS: Numerical Rating Scale (0-10, where 0 = no pain and 10 = worst imaginable pain).

Table 5 Postoperative recovery outcomes, mean ± SD/n (%)

Outcome	Intervention group (n = 71)	Control group (n = 70)	P value
Time to first ambulation (hours)	18.3 ± 4.2	24.7 ± 6.8	< 0.001
Time to first bowel movement (days)	2.6 ± 0.8	3.4 ± 1.2	< 0.001
Length of hospital stay (days)	6.8 ± 1.9	8.4 ± 2.7	< 0.001
Any postoperative complications	12 (16.9)	18 (25.7)	0. 218
Specific complications
Persistent pain requiring intervention	5 (7.0)	13 (18.6)	0.036
Sleep disturbance	9 (12.7)	20 (28.6)	0.012
Wound infection	3 (4.2)	5 (7.1)	0.469
Ileus	2 (2.8)	4 (5.7)	0.431

P values were calculated using independent t-tests for continuous variables and χ² or Fisher’s exact tests for categorical variables.

Table 6 Quality of life scores, mean ± SD

Domain	Time point	Intervention group	Control group	P value
Global health status	Baseline	52.3 ± 13.5	51.8 ± 14.2	0.829
	Postoperative day 7	54.2 ± 12.3a	45.7 ± 14.8	< 0.001
	1-month follow-up	67.8 ± 11.9b	58.4 ± 13.7	< 0.001
Physical functioning	Baseline	76.4 ± 12.8	75.9 ± 13.4	0.816
	Postoperative day 7	62.8 ± 11.4c	52.1 ± 13.9	< 0.001
	1-month follow-up	74.3 ± 10.7	66.2 ± 12.8	< 0.001
Emotional functioning	Baseline	58.3 ± 15.4	57.9 ± 16.1	0.877
	Postoperative day 7	68.3 ± 13.2d	54.9 ± 15.7	< 0.001
	1-month follow-up	78.6 ± 12.4	68.4 ± 14.9	< 0.001
Social functioning	Baseline	65.7 ± 14.3	64.8 ± 15.1	0.712
	Postoperative day 7	59.7 ± 12.8	48.3 ± 14.2	< 0.001
	1-month follow-up	72.4 ± 11.6	62.7 ± 13.8	< 0.001
Fatigue (symptom scale)	Baseline	45.6 ± 16.8	46.2 ± 17.3	0.838
	Postoperative day 7	42.3 ± 13.5	56.8 ± 16.2	< 0.001
	1-month follow-up	32.7 ± 11.9	43.5 ± 14.7	< 0.001
Pain (symptom scale)	Baseline	38.4 ± 14.6	39.1 ± 15.2	0.782
	Postoperative day 7	35.7 ± 12.1	51.4 ± 15.8	< 0.001
	1-month follow-up	24.8 ± 10.3	36.2 ± 13.6	< 0.001
Insomnia (symptom scale)	Baseline	42.7 ± 15.9	43.5 ± 16.4	0.772
	Postoperative day 7	31.2 ± 11.7	48.9 ± 14.3	< 0.001
	1-month follow-up	26.4 ± 10.2	39.7 ± 13.1	< 0.001

^aP < 0.05 vs baseline within the intervention group.

^bP < 0.001 vs baseline within the intervention group.

^cP < 0.001 vs baseline within the intervention group.

^dP < 0.001 vs baseline within the intervention group.

Functional scales and global health status; higher scores indicate better functioning (0-100 scale). Symptom scales: Higher scores indicate more severe symptoms (0-100 scale). This table presents European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 scores at baseline, postoperative day 7, and 1-month follow-up.

Table 7 Patient satisfaction and preparedness, n (%)

Parameter	Intervention group (n = 71)	Control group (n = 70)	P value
Overall satisfaction with care (1-5 scale), mean ± SD	4.6 ± 0.5	3.8 ± 0.7	< 0.001
Felt well-prepared for surgery	65 (91.5)	46 (65.7)	< 0.001
Confident in ability to cope with recovery	63 (88.7)	41 (58.6)	< 0.001
Would recommend the care received	68 (95.8)	52 (74.3)	< 0.001
Satisfaction with pain management	66 (93.0)	48 (68.6)	< 0.001
Satisfaction with emotional support	67 (94.4)	38 (54.3)	< 0.001

Satisfaction scale: 1 = very dissatisfied, 2 = dissatisfied, 3 = neutral, 4 = satisfied, and 5 = very satisfied.

Table 8 Healthcare resource utilization, n (%)

Parameter	Intervention group (n = 71)	Control group (n = 70)	P value
Anxiolytic medication prescribed	6 (8.5)	19 (27.1)	0.003
Sleep medication prescribed	8 (11.3)	22 (31.4)	0.002
Additional pain management consultation	4 (5.6)	12 (17.1)	0.027
Psychiatric consultation required	2 (2.8)	8 (11.4)	0.049
30-day readmission	3 (4.2)	7 (10.0)	0.131
30-day emergency department visit	5 (7.0)	10 (14.3)	0.149
Total hospital costs (USD), mean ± SD	12345 ± 2678	14782 ± 3421	< 0.001

USD: United States dollars.