Preoperative Psychosocial and Spiritual Health and Postoperative Complications After Colorectal Cancer Surgery: A Prospective Cohort Study

OBJECTIVE: Postoperative complications following colorectal cancer resection remain common despite technical advances, yet associations of psychosocial and spiritual health with surgical risk are poorly characterized. METHODS: This prospective cohort study enrolled 985 patients undergoing colorectal cancer resection at a single tertiary center (2013-2021). Preoperative assessments included health behaviors (Smart Management Strategy for Health Assessment Tool), self-rated health status (5 Health Status Questionnaire), and health-related quality of life (EORTC QLQ-C30). The primary outcome was any complication within 30 days; secondary outcomes were complication subtype (surgical vs. non-surgical) and severity (minor vs. major). Multivariable stepwise logistic regression was performed per outcome. RESULTS: Overall, 305 patients (31.0%) experienced at least one complication: 235 surgical (23.9%), 106 non-surgical (10.8%), and 32 major (3.3%). Lower positive-thinking behavior was associated with overall (OR 1.52; 95% CI 1.11-2.07) and minor complications (OR 1.52; 95% CI 1.11-2.09); lower helping-others behavior with surgical complications (OR 2.06; 95% CI 1.27-3.35); and poor spiritual health with non-surgical complications (OR 2.11; 95% CI 1.37-3.26). Preoperative fatigue showed the strongest association with major complications (OR 4.04; 95% CI 1.60-10.21). CONCLUSIONS: Distinct psychosocial and spiritual health domains were associated with distinct complication subtypes, with preoperative fatigue showing the strongest association with major complications. Whether these reflect modifiable contributors or markers of underlying vulnerability cannot be determined from an observational design; the findings identify patients who may benefit from additional supportive resources rather than a basis for risk stratification.