Mental health outcomes following emergent versus elective colorectal surgery
Samantha J. Scarola, Shreyus S. Kulkarni, Scott T. Rehrig, Cristina B. Feather, Justin D. Turcotte, John R. KluneAbstract
Introduction
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.
Methods
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.
Results
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).
Conclusion
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.