Health status, anxiety, and depressive symptoms following complicated and uncomplicated colorectal surgeries.
OBJECTIVE
The purpose of this study was to evaluate the impact of complications following colorectal surgery on anxiety, depressive symptoms, and health status. Previously, very few studies examined the psychological impact of complications following colorectal surgery. Also, in clinical practice, little attention is paid to the psychological impact of complications.


METHODS
Patients undergoing colorectal surgery were evaluated prospectively preoperatively and postoperatively at 3 days, 6 weeks, and 1 year, using the Center for Epidemiological Studies-Depression (CES-D), State-Trait Anxiety Inventory (STAI), and Short Form 36 (SF-36) questionnaires. Patient data and complications were prospectively recorded. Postoperative CES-D, STAI, and SF-36 scores in patients with minor and severe complications were compared to scores of patients without complications using a general linear model.


RESULTS
Of 218 patients, 130 (59.6%) had complications. Colorectal surgery significantly increased depressive symptoms and anxiety levels in the same amount in all patient subgroups. Furthermore, it also lowered all domains of health status in all patient subgroups, but not equally. Patients with a severely complicated postoperative course had a larger postoperative decrease in health status, most notably at 6 weeks postoperatively with the largest effects in the physical-, mental-, social-, and vitality domains compared with the other subgroups.


CONCLUSIONS
Colorectal surgery has a profound effect on depressive and anxiety symptoms, as well as nearly all domains of health status. Occurrence of severe complications increases the negative effect of colorectal surgery on most domains of health status but do not specifically increase depressive symptoms or anxiety levels. At 6 weeks, these effects are most notable, but at 1 year, they have faded.
Department of Surgery, Martini Hospital, PO Box 30033, 9700 RM, Groningen, The Netherlands. Eelke.bosma@mzh.nl.
Eelke
E
Bosma
Center of Research on Psychology in Somatic Disease (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
Marleen J J
MJ
Pullens
Center of Research on Psychology in Somatic Disease (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.|Department of Medical Psychology, St. Elisabeth Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands.
Jolanda
J
de Vries
Center of Research on Psychology in Somatic Disease (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.|Department of Medical Psychology, St. Elisabeth Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands.|Department of Surgery, St. Elisabeth Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands.
Jan A
JA
Roukema
D000368:Aged; D001007:Anxiety / Q000209:etiology*; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D003863:Depression / Q000209:etiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000523:psychology*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D011795:Surveys and Questionnaires
Anxiety; Colorectal surgery; Complications; Depression; Health status