Combined impact of nutritional and inflammatory status and depressive symptoms on mortality following hysterectomy

Hysterectomy is a common surgery for women, where nutrition, inflammation, and depression impact recovery. These factors are interconnected. Although previous studies have explored the changes in nutrition and inflammation after hysterectomy, there is still no reliable biomarker to predict adverse postoperative outcomes. Additionally, the role of depression in postoperative recovery should not be overlooked. This study aims to fill this gap by identifying the advanced lung cancer inflammation index (ALI) as a potential indicator of poor postoperative prognosis following hysterectomy. It also seeks to examine the combined effect of ALI and depression on postoperative mortality. This study uses NHANES data (2005–2023) and employs multivariable Cox proportional hazards regression models, restricted cubic spline plots, subgroup analysis, threshold analysis, and mediation analysis to evaluate the independent and combined effects of ALI and PHQ-9 depression scores on postoperative mortality following hysterectomy. Over 18 years, 620 all-cause and 150 cardiovascular-related deaths were recorded. Multivariable-adjusted analysis showed that high ALI was significantly linked to a lower risk of both all-cause and cardiovascular mortality. In contrast, women with PHQ-9 scores ≥ 10 had a significantly higher risk of death. Combined analysis showed that women with high ALI and no depression had the lowest mortality risk. Further analysis confirmed that ALI was negatively correlated with mortality, while depression scores increased the risk. This study identifies ALI as a biomarker for poor postoperative prognosis and highlights the combined effects of nutrition, inflammation, and depression. Proper control of these factors reduces mortality risk post-hysterectomy.