Short-term psychiatric risk after inflammatory bowel disease surgery: a propensity score-matched analysis by disease severity

Background Inflammatory bowel disease (IBD) can be associated with psychiatric comorbidity, including anxiety and depression. Prior studies suggest an increase in mood disorders after IBD surgery, but the magnitude and timing of the risk related to disease severity remain incompletely defined. Methods Using the TriNetX US Collaborative Network, we conducted a cohort study of adults aged 18 to 65 years with newly diagnosed IBD between January 1, 2016, and June 30, 2020. Patients who underwent IBD-related surgery within 5 years of their first IBD diagnosis were matched with nonsurgical controls. Two treatment strata were analyzed: 5-aminosalicylates (5-ASAs) and biologics. The primary outcomes were incident anxiety and depression within 6 months of the index event. Results Propensity score matching yielded 1255 patients in each of the 5-ASA cohorts (surgical and nonsurgical) and 2492 patients in each of the biologic cohorts. Among patients treated with 5-ASAs, incident anxiety occurred in 8.77% of surgical patients vs 8.05% of nonsurgical patients (risk difference [RD], 0.72%; 95% CI, −1.45 to 2.89; P =.52). Depression occurred in 6.93% vs 5.10%, respectively (RD, 1.83%; 95% CI, −0.03 to 3.69; P =.053). In patients treated with biologics, surgery was associated with a significantly higher incidence of anxiety (12.08% vs 6.86%; RD, 5.22%; 95% CI, 3.60–6.84; P <.0001) and depression (6.74% vs 4.09%; RD, 2.65%; 95% CI, 1.39–3.90; P <.0001). Discussion IBD-related surgery was associated with an increased short-term incidence of anxiety and depression among patients receiving biologic therapy but not among those treated with 5-ASAs. These findings suggest that postoperative psychiatric vulnerability may be greater among patients with more advanced disease, highlighting the need for perioperative mental health screening and support in this population.