Mental health outcomes following emergent versus elective colorectal surgery.

Abstract

Emergency surgery carries risk for psychological adverse events, yet procedure-specific mental-health outcomes remain poorly characterized. This study evaluated the association between surgical acuity (emergent vs elective), ostomy formation and new-onset postoperative mental-health conditions following colorectal surgery. A retrospective cohort study of patients undergoing emergent or elective colorectal surgery from 2015 to 2025 in the TriNetX research-network was performed. Patients with pre-existing mental-health diagnoses were excluded. Analyses were stratified a priori by procedure type (anastomosis vs ostomy). Within these cohorts, emergent and elective cases were 1:1 propensity-score-matched on 55 patient-characteristics. Rates of new-onset depression, anxiety, post-traumatic stress disorder (PTSD), stress reaction/adjustment disorders and suicidal ideation, attempts, or self-harm within 1-year postoperatively were compared between groups using univariable analyses. In the anastomosis cohort (n = 8,880), emergent surgery was associated with higher rates of depression (4.03% vs 2.77%; p = 0.001), anxiety (5.20% vs 4.23%; p = 0.031) and stress reaction/adjustment disorders (2.03% vs 1.28%; p = 0.006). Overall, emergent procedures carried a 36% increased relative-risk of any adverse mental-health outcome (9.30% vs 6.82%; RR: 1.36; p < 0.001). In the ostomy cohort (n = 6,748), emergent surgery was associated with higher rates of depression (7.44% vs 4.89%; p < 0.001), anxiety (8.20% vs 6.31%; p = 0.003) and stress-related disorders (2.79% vs 1.63%; p = 0.001), with a 35% increased relative-risk of any adverse mental-health event (14.26% vs 10.58%; RR: 1.35; p < 0.001). Emergent colorectal surgery was associated with significantly higher rates of postoperative mental-health disorders compared with elective operations across both anastomosis and ostomy creation groups, suggesting that the acuity of surgical presentation is a critical determinant of postoperative psychological recovery.