Subtypes and influencing factors of postoperative burden outcomes in patients with moyamoya disease: A latent transition analysis based on multidimensional evaluation

Abstract Background Moyamoya disease is a chronic, progressive cerebrovascular condition, and revascularisation surgery remains its primary treatment. However, how patients' burden evolves throughout the perioperative period remains understudied. We classified patients' self-perceived burden into subtypes before and after revascularisation, tracking how individuals shifted between subtypes. Factors linked to an unfavourable burden outcome were examined. The findings may inform perioperative risk stratification and the timing of assessment. Methods This longitudinal study followed adults scheduled for elective cerebral revascularisation at a tertiary Chinese hospital from July 2025 to June 2026. Each patient completed assessments one day before surgery (T1) and one day before discharge (T2). Burden was measured with the Self-Perceived Burden Scale, and anxiety was measured with the Generalized Anxiety Disorder-7. The LPA used the three SPBS subscale scores (physical, emotional and financial burden), and GAD-7 entered the model as an auxiliary variable. Latent transition analysis modelled how individual patients shifted between subtypes. Remaining in a higher-burden subtype or progressing into a subtype defined an unfavourable outcome. Univariate comparisons screened for candidate factors, which were subsequently subjected to multivariable logistic regression. Results The sample comprised 171 patients (male: 54.4%), with a mean age of 44.7 years. Three burden subtypes (low, moderate and high) were identified at both assessments; between assessments, the low-burden subtype prevalence decreased from 36.3% to 13.5%, and the high-burden subtype increased from 14.6% to 27.5%, leaving 133 patients (77.8%) with an unfavourable outcome. Postoperative aphasia was associated with higher odds of an unfavourable outcome (OR: 5.387, 95% CI: 1.200–24.189, P = 0.028), whereas a history of anxiety or depression was associated with lower odds (OR: 0.360, 95% CI: 0.158–0.820, P = 0.015). Conclusions In this cohort of 171 adults undergoing elective revascularisation for moyamoya disease, 77.8% demonstrated no change to a lighter profile. Postoperative aphasia indicated the highest risk, whereas a history of anxiety or depression was linked to better outcomes, suggesting that preadmission burden and anxiety screening, closer monitoring for aphasia and predischarge reassessment may inform perioperative patient management.