Depression can affect surgical outcomes and postoperative costs

Depression is known to be associated with physical health challenges, in everything from disrupting sleep to an increased cancer risk. Depression can also affect surgical outcomes and postoperative costs, according to new study findings. 

The research will be presented at the American College of Surgeons (ACS) Clinical Congress 2025 in Chicago, October 4-7. 

Researchers from The Ohio State University in Columbus, Ohio, and The Ohio State University Wexner Medical Center found that patients with depression are less likely to have an optimal surgical recovery. However, patients treated with antidepressants performed better in multiple surgical outcomes areas. 

Treating any diagnosis, especially one as substantial and devastating as cancer, requires an understanding of other health and social risk factors. Understanding how mental health issues impact postoperative outcomes can help create holistic and individualized treatment plans, anticipate and prevent associated complications, and ultimately optimize patient outcomes." 

Erryk S. Katayama, fourth-year medical student at The Ohio State University College of Medicine and lead author on the study

In this retrospective study, researchers looked at Surveillance, Epidemiology, and End Results (SEER)-Medicare data to identify patients with colorectal, hepatobiliary, and pancreatic cancers who were also diagnosed with depression 12 months before or after a cancer diagnosis. Through Medicare Part D data, the researchers also identified which patients had a prescription for antidepressants. Researchers then looked at whether those patients had an "ideal" post-surgery outcome, which meant they did not report complications, have a long hospital stay, were not readmitted to the hospital within 90 days, or died within 90 days of surgery. 

Out of 32,726 patients, 1,731 were also diagnosed with depression. Of those patients, 1,253 had received an antidepressant prescription and 478 had not. 

Key findings 

• Researchers found that patients with depression, whether treated or not, had worse post-surgical recovery and higher costs. However, antidepressants lowered those effects. 

• While patients without depression fared best overall, those with treated depression had better outcomes, reduced lengths of stay and readmission, and lower rates of mortality. 

• Patients without depression also had the lowest cost of care ($17,551), followed by patients who were treated ($22,086, 7.3% increase) and untreated ($24,897, a 10.2% increase) for depression. 

The researchers noted that previous studies have shown that patients with depression are more likely to be nonadherent to medical therapy. "Treatment of that depression may help mitigate and treat depression and allow better self-care and treatment compliance," said Timothy M. Pawlik, MD, MPH, PhD, FACS, a surgical oncologist at The Ohio State University Wexner Medical Center and senior author of the study. 

The inspiration for this research came out of the COVID-19 pandemic, which brought an increased awareness of mental health. 

"We began to think of the implications of mental health on surgical outcomes, and talking about health-related social needs," said Dr. Pawlik. Those factors included food insecurity, job insecurity, and domestic violence. 

Dr. Pawlik noted that the researchers used antidepressant prescriptions as an indicator of who did or did not receive treatment and they did not consider if a patient was in therapy or seeing a psychiatrist, which is a limitation of the study. However, the results indicate the importance of screening for depression before surgery, "so we can address the needs of our patients," he said. The researchers also stressed the importance of patients to not ignore their mental health, especially when undergoing surgery. 

"We are asking our patients to be participants in their care because it helps them to be their best self and in the best place they can be," Dr. Pawlik said. 

Co-authors are Sidharth Iyer, BS; Selamawit Woldesenbet, PhD; and Mujtaba Khalil, MBBS.