Trajectory Patterns of Perioperative Anxiety and Depressive Symptoms in Patients With Digestive System Malignancies and Their Impact on Postoperative Outcomes

Abstract

Background: To identify perioperative anxiety and depressive symptom trajectoriesin patients with digestive system malignancies undergoing surgery and to examine their associations with biomarkers and postoperative outcomes.

Methods: This retrospective cohort study included 285 patients with digestive system malignancies who underwent elective surgery from January 2019 to December 2025 at Zhejiang Xinan International Hospital. Anxiety and depressive symptoms were assessed using repeated Hospital Anxiety and Depression Scale (HADS) total scores at T1 (1–3 days preoperatively), T2 (postoperative day 3), and T3 (postoperative day 7). Self-Rating Anxiety Scale, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and Social Support Rating Scale scores were also extracted. Biomarkers, including cortisol, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF), were obtained from routine laboratory records. Latent class growth analysis was used to identify symptom trajectories. Multivariate logistic regression was performed to identify predictors of chronic trajectory membership.

Results: Three trajectories were identified: resilient (42.1%), recovery (38.2%), and chronic (19.6%). Stage III patients had higher HADS scores than Stage I patients (18.6 ± 4.8 vs. 12.4 ± 3.6, p < 0.001). The chronic group showed higher postoperative IL-6 (8.2 ± 2.4 vs. 4.8 ± 1.6 pg/mL), TNF-α (18.6 ± 5.2 vs. 10.2 ± 3.4 pg/mL), and CRP levels, and lower BDNF levels than the resilient group. Chronic trajectory membership was associated with higher complication rates, longer hospital stay, higher 30- day readmission, and lower Quality of Recovery-15 (QoR15) scores. Independent predictors included Stage III disease, psychiatric history, preoperative sleep disturbance, and reduced social support. The prediction model showed good (area under the receiver operating characteristic curve (AUC) = 0.856). 

Conclusions: Perioperative psychological distress follows distinct trajectories in patients with digestive system malignancies. Persistent distress is associated with inflammatory activation and poorer postoperative recovery, supporting early risk stratification and targeted psychological intervention.