Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2017; 23(48): 8651-8659
Published online Dec 28, 2017. doi: 10.3748/wjg.v23.i48.8651
Psychiatric morbidity after surgery for inflammatory bowel disease: A systematic review
Marie Strøm Zangenberg, Alaa El-Hussuna
Marie Strøm Zangenberg, Center for Surgical Science, Department of Surgery, Zealand University Hospital, Køge 4600, Denmark
Alaa El-Hussuna, Department of Surgery, Aalborg University Hospital, Aalborg 9100, Denmark
Author contributions: Both authors contributed to conceiving and designing the study, collecting the data, analyzing and interpreting the data, writing the manuscript and approving the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alaa El-Hussuna, MSc, Doctor, Consultant Surgeon, Department of Surgery, Aalborg University Hospital, Hobrovej 18-22, Aalborg 9100, Denmark. alaa@itu.dk
Telephone: +45-28944902 Fax: +45-97660000
Received: August 29, 2017
Peer-review started: August 30, 2017
First decision: September 13, 2017
Revised: September 14, 2017
Accepted: October 17, 2017
Article in press: October 17, 2017
Published online: December 28, 2017
Abstract
AIM

To examine the evidence about psychiatric morbidity after inflammatory bowel disease (IBD)-related surgery.

METHODS

PRISMA guidelines were followed and a protocol was published at PROSPERO (CRD42016037600). Inclusion criteria were studies describing patients with inflammatory bowel disease undergoing surgery and their risk of developing psychiatric disorder.

RESULTS

Twelve studies (including 4340 patients) were eligible. All studies were non-randomized and most had high risk of bias. Patients operated for inflammatory bowel disease had an increased risk of developing depression, compared with surgical patients with diverticulitis or inguinal hernia, but not cancer. In addition, patients with Crohn’s disease had higher risk of depression after surgery compared with non-surgical patients. Patients with ulcerative colitis had higher risk of anxiety after surgery compared with surgical colorectal cancer patients. Charlson comorbidity score more than three and female gender were independent predictors for depression and anxiety following surgery.

CONCLUSION

The review cannot give any clear answer to the risks of psychiatric morbidity after surgery for IBD studies with the lowest risk of bias indicated an increased risk of depression among surgical patients with Crohn’s disease and increased risk of anxiety among patients with ulcerative colitis.

Keywords: Inflammatory bowel disease, General surgery, Psychiatry, Depression, Anxiety, Postoperative complications

Core tip: Patients with inflammatory bowel disease (IBD) have higher risk of depression after surgery compared with patients operated for diverticulitis or inguinal hernia but not cancer. Patients with ulcerative colitis (UC) might have higher risk of anxiety after surgery compared with patients with colorectal cancer. Compared with nonsurgical patients, patients operated for UC have higher risk of anxiety and patients operated for Crohn’s disease have higher risk of depression. Among patients with IBD, female gender and Charlson comorbidity score > 3 are risk factors for both anxiety and depression following surgery.