Effect of postoperative esketamine on depression after pancreatoduodenectomy: a randomized controlled trial

Abstract

Background

Pancreaticoduodenectomy (PD) can lead to major trauma in terms of patients’ mental health, including severe postoperative depression. This study aimed to investigate the effects of supplementing patient-controlled analgesia with low-dose esketamine on postoperative depression among patients undergoing PD.

Methods

Eighty patients who were scheduled for PD were randomly assigned to either the control or esketamine groups. The control group received 2 µg/kg of sufentanil for patient-controlled analgesia (PCIA), whereas the esketamine group received a combination of 1.5 mg/kg esketamine and 2 µg/kg sufentanil. The primary outcome was the incidence of depression on the third postoperative day. The secondary outcomes included the Hamilton Depression Scale (HAMD-17) scores on the first, second, third, and fifth postoperative days; the severity of postoperative pain; the analgesic dosage; the incidence of postoperative adverse effects; the concentrations of plasma 5-hydroxytryptamine (5-HT), brain-derived neurotrophic factor (BDNF), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α); and the one-year survival rate.

Results

The incidence of depression on the third postoperative day did not differ significantly between the two groups (47.1% vs. 42.9%, P = 0.726). However, the change in the HAMD-17 score between baseline and the fifth postoperative day was significantly lower in the esketamine group (P = 0.029). The number of PCIA button presses was significantly lower in the esketamine group than in the control group (9.32 ± 6.48 vs. 6.54 ± 4.39, P = 0.040), and opioid usage was also significantly lower in the esketamine group (114.9 ± 23.32 vs. 100.9 ± 25.72, P = 0.021). Furthermore, esketamine decreased the plasma concentration of IL-6 on the first postoperative day (P < 0.05) and that of TNF-α on the fifth postoperative day (P < 0.05).

Conclusion

The postoperative administration of esketamine may reduce the need for analgesics among patients undergoing PD, alleviate peripheral inflammation, and potentially improve postoperative depressive symptoms.

Trial registration

This trial was registered at http://www.chictr.org.cn (ChiCTR2200066303, Principal investigator: Yinqing Yin, Date of registration: 2022–11–30).

Supplementary Information

The online version contains supplementary material available at 10.1186/s13741-026-00711-3.

Introduction

Pancreatic cancer is characterized by highly aggressive progression and remarkably low survival rates (Luo et al. 2020; Sung et al. 2020). Despite significant advances in medical therapies that have greatly improved the prognosis of patients with various types of cancer, the outcomes of individuals diagnosed with pancreatic cancer have barely improved (Rahib et al.2014). Pancreatoduodenectomy (PD) is the conventional surgical intervention used to manage pancreatic cancer and some benign conditions. This procedure is invasive and technically challenging and is characterized by high incidences of perioperative complications and mortality (Yu et al. 2023). Surgery can be a distressing and painful event for patients, frequently leading to negative emotions such as anxiety and depression (Luo et al. 2024).

Depression appears to be more common in pancreatic cancer patients than in the general population, with the reported prevalence ranging from 33 to 55% (Barnes et al. 2018). Studies involving patients with pancreatic cancer have demonstrated correlations between depressive symptoms and poor quality of life, reduced adherence to treatment protocols, and increased mortality (Jia et al. 2010; Boyd et al. 2012). Delaying the management of postoperative depression can prolong hospitalization durations, increase the risk of complications, and increase medical costs (Kang et al. 2022). Therefore, alternative medications should be identified to address the urgent clinical needs of individuals experiencing postoperative depression (Yu et al. 2023).

Previous research has demonstrated that the use of sufficient analgesia can decrease the occurrence of depression (Campos et al. 2022). Ketamine, which is a novel analgesic agent that has attracted attention in recent years, is effective in the management of treatment-resistant depression (Canuso et al. 2018; Zanos et al. 2018). The main mechanism involves the inhibition of N-methyl-D-aspartate (NMDA) receptors. In recent years, the antidepressant properties of ketamine have been investigated, as a single subanesthetic dose can induce rapid (i.e., within hours) and prolonged antidepressant effects in patients who do not respond to traditional antidepressant therapies (Singh et al. 2017). Furthermore, esketamine can enhance short-term mood disturbances and alleviate pain in individuals who undergo cervical cancer surgery (Wang et al. 2019, 2020).

However, the application of esketamine predominantly involves single-dose administration. Therefore, the potential analgesic and antidepressant effects of continuous postoperative esketamine use remain unclear. Thus, this study aimed to investigate whether the postoperative administration of esketamine can ameliorate depressive symptoms in patients undergoing PD. Additionally, postoperative pain levels, complications, and plasma levels of biomarkers such as interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), brain-derived neurotrophic factor (BDNF), and 5-hydroxytryptamine (5-HT) were monitored.

Methods

Study setting and design

This single-center, double-blind, randomized controlled trial was conducted in the Department of Anesthesiology at Tianjin Medical University Cancer Institute and Hospital between January 2023 and December 2024. The trial was approved by the hospital’s Clinical Research Ethics Committee (E20221148). This trial was registered prior to patient enrollment at http://www.chictr.org.cn (ChiCTR2200066303, Principal investigator: Yinqing Yin, Date of registration: 2022–11–30). All participants provided written informed consent prior to enrollment.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) aged between 18 and 65 years; (2) scheduled to undergo PD; and (3) an American Society of Anesthesiologists (ASA) physical status classification of I to III. The exclusion criteria were as follows: (1) use of opioid medications prior to surgery; (2) a history of substance abuse, including drug addiction, alcoholism, or medication misuse; (3) cognitive dysfunction prior to surgery; (4) a significant history of cerebrovascular disease; (5) a history of mental health disorders, specifically a confirmed diagnosis of depression managed with long-term pharmacological treatment; and (6) contraindications to esketamine treatment.

Randomization and blinding procedures​

A randomization code table was generated via SPSS 21.0 (IBM Corp., Armonk, NY, USA) on the basis of the sample size with an allocation ratio of 1:1. Participants meeting the inclusion criteria were allocated to either the control group or the esketamine group. The esketamine group received a postoperative analgesic regimen consisting of ​1.5 mg/kg esketamine combined with 2 μg/kg sufentanil, whereas the control group received ​2 μg/kg sufentanil. These doses were selected on the basis of our preliminary experimental findings (Yu et al. 2023).

To ensure methodological rigor, a ​double-blind design in which all the investigators, participants, data collectors, and statisticians remained blinded to group assignments throughout the study period was employed. Unblinding was strictly prohibited unless necessitated by ​critical safety concerns​ or other ​unforeseen severe adverse events​ warranting immediate intervention.

Treatment implementation

Upon their arrival in the operating room, all patients underwent ​standardized multiparametric monitoring, including pulse oximetry (SpO₂), electrocardiography (ECG)​​, noninvasive blood pressure (NIBP)​​, invasive arterial blood pressure (IABP),​​ and bispectral index (BIS)​ measurements.

​Anesthesia was induced by the sequential intravenous administration of etomidate​ (0.3 mg/kg), sufentanil​ (0.4–0.6 μg/kg), and rocuronium (0.6–0.9 mg/kg). Anesthesia was maintained via continuous infusion of propofol​ (4–8 mg/kg/h) and remifentanil​ (6–12 μg/kg/h). Sevoflurane inhalation was also used if necessary. Intermittent boluses of cisatracurium​ were administered to maintain neuromuscular relaxation. Residual neuromuscular blockade was pharmacologically reversed with ​neostigmine and atropine​ when necessary. After surgery, patients were transferred to the ​post-anesthesia care unit (PACU). Discharge to the general ward was permitted when the ​Alderete recovery score was > 9.

Intravenous patient-controlled analgesia (PCIA) was provided for all patients. A multimodal analgesic regimen comprising sufentanil (2 μg/kg) combined with esketamine (1.5 mg/kg) was injected in the intervention arm, whereas an identical volume of sufentanil (2 μg/kg) was injected into the control arm. All the study medications were uniformly diluted in a sterile 0.9% sodium chloride solution to a final volume of 150 mL. The continuous basal infusion rate was 1 mL/h, and the patient-controlled bolus rate was 2 mL per se. The lockout interval was 10 min, and the therapeutic duration was more than 72 h.

Data collection

The primary outcome of this study was the incidence of depression on postoperative day (POD) 3. The secondary outcomes were as follows: (1) Hamilton Depression Scale (HAMD-17) scores measured preoperatively and on PODs 1, 2, 3, and 5; (2) visual analog scale (VAS) scores measured immediately after PACU admission and on PODs 1, 2, 3, and 5; (3) total postoperative doses of sufentanil and esketamine; (4) number of PCIA button presses, supplemental analgesic requirements, and rescue medication usage; (5) incidence of postoperative complications and adverse events; (6) length of postoperative hospital stay; (7) plasma concentrations of BDNF, 5-HT, TNF-α, and IL-6 measured preoperatively and on PODs 1, 3, and 5; and (8) patient survival rates at the 6-month and 12-month follow-ups.

Sample size calculation

The clinical efficacy of esketamine in preventing postoperative depression has not yet been established. Current evidence indicates that the response rate to esketamine ranges from 26 to 56% in patients with major depressive disorder. On the basis of these findings, we hypothesized that there would be a 30% difference in response rates between the treatment groups on POD 3. A power analysis revealed that 38 patients per group would be needed to achieve 80% statistical power, with a two-sided type I error of 0.05. Accounting for a potential 5% loss to follow-up, we determined that a total sample size of 80 patients (40 per group) would provide adequate statistical power for this study.

Statistical methods

Statistical analyses were performed using SPSS (version 24.0; IBM Corp) and GraphPad Prism (version 8.3; GraphPad Software). The normality of the data distribution was assessed using the Shapiro‒Wilk test supplemented by visual inspection of the Q‒Q plots. Continuous variables with a normal distribution are expressed as the mean ± standard deviation (SD) and were analyzed using Student’s t test. Nonnormally distributed variables are reported as medians with interquartile ranges (IQRs) and were analyzed using the Kruskal‒Wallis rank sum test. Categorical variables are presented as counts with proportions (%) and were compared using either the χ² test or Fisher’s exact test, as appropriate. A two-tailed P < 0.05 was considered to indicate statistical significance for all analyses.

Results

Patient information

The study flowchart is depicted in Fig. 1. A total of 80 patients were included in the randomization phase of the study. However, owing to the refusal of five participants to continue the trial, modifications in the surgical approach for three patients, and loss to follow-up for another three patients, 69 individuals were ultimately included in the final data analysis. Among these patients, 34 patients were assigned to the control group, whereas 35 patients were allocated to the esketamine group. The preoperative demographic information of the two groups was not significantly different (Table 1).

Fig. 1.

CONSORT flow diagram of this study

Table 1.

Demographic characteristics of the two patient cohorts

	Control group (n = 34)	Esketamine group (n = 35)	P value
Age (y)	56.38 ± 8.56	55.94 ± 7.952	0.826
BMI (kg/m2)	23.69 ± 2.74	23.11 ± 2.90	0.395
Gender
Male	19 (55.9)	21 (60.0)
Female	15 (44.1)	14 (40.0)	0.729
Hypertension
Yes	23 (67.6)	26 (74.3)
No	11 (32.4)	9 (25.7)	0.543
Diabetes
Yes	26 (76.5)	29 (82.9)
No	8 (23.5)	6 (17.1)	0.510
Heart disease
Yes	30 (88.2)	33 (94.3)
No	4 (11.8)	2 (6.3)	0.642
Smoking
Yes	21 (61.8)	16 (45.7)
No	13 (38.2)	19 (54.3)	0.181
Alcoholism
Yes	20 (58.8)	16 (45.7)
No	14 (41.2)	19 (54.3)	0.276
Education
Primary school	26 (76.5)	26 (74.3)
Middle school	3 (8.8)	3 (8.6)
High school	5 (14.7)	5 (14.3)
University	0 (0)	1 (2.8)	0.712
ASA
Ⅱ	2 (5.9)	2 (5.7)
Ⅲ	32 (94.1)	33 (94.3)	1

Data are presented as mean ± SD or number (percentage)

Abbreviations: ASA American Society of Anesthesiologists, BMI body mass index

Incidence of depression

On the basis of the scoring criteria of the HAMD-17, we assessed the occurrence of depression among the patients. Depression was defined as a score greater than 7 on the HAMD-17. The incidence of depression on POD 3 did not significantly differ between the two groups (47.1% vs. 42.9%, P = 0.726; Table 2).

Table 2.

Incidence of depression

	Depression	Control group (n = 34)	Esketamine group (n = 35)	P value
Pre-operation	No	28 (82.4)	25 (71.4)	0.282
	Yes	6 (17.6)	10 (28.6)
POD 1	No	16 (47.1)	17 (48.6)	0.900
	Yes	18 (52.9)	18 (51.4)
POD 3	No	18 (52.9)	20 (57.1)	0.726
	Yes	16 (47.1)	15 (42.9)
POD 5	No	23 (67.6)	23 (65.7)	0.865
	Yes	11 (32.4)	12 (34.3)

Data are presented as number (percentage)

POD postoperative day

The preoperative HAMD-17 scores of the two groups appeared to differ. Although this difference was not statistically significant, the change in the HAMD-17 scores following the operation was analyzed. The results indicated no statistically significant difference in the change in the HAMD-17 scores on POD 3 between the esketamine and control groups. However, by POD 5, the change in the HAMD-17 scores in the esketamine group was significantly lower than that in the control group (P = 0.029; Table 3). Moreover, we compared the incidence of newly developed depression among patients. We defined newly developed postoperative depression as the absence of depression prior to surgery but the presence of depression at any time on PODs 1, 3, or 5. The results indicated no statistically significant difference in the incidence of new-onset depression or the HAMD-17 scores between the two groups (Supplementary Tables 1 and 2).

Table 3.

The variations in HAMD-17 scores

	Control group (n = 34)	Esketamine group (n = 35)	P value
POD 1	3.5 (1, 6.25)	3 (1, 5)	0.259
POD 3	2 (1, 5)	1 (0, 3)	0.050
POD 5	1 (0, 2)	0 (0, 1)	0.029

Data are presented as median (IQR). The variations are obtained by subtracting the preoperative score from the postoperative score

POD postoperative day

Postoperative pain

As shown in Table 4, there were no statistically significant differences in the VAS scores between the two groups at the time of admission to the PACU or at 6 h, 1 day, 2 days, 3 days, or 5 days after the operation (P > 0.05). However, the number of PCIA button presses in the esketamine group was significantly lower than that in the control group (P = 0.040; Table 5). To calculate postoperative opioid consumption, the amount of sufentanil used in the analgesia pump and the dosage of analgesics used for rescue analgesia were converted to the morphine equivalence dosage for analysis. The dosage of opioids administered to patients in the esketamine group postoperatively was significantly lower than that in the control group (P = 0.021; Table 5).

Table 4.

The VAS scores

	Control group (n = 34)	Esketamine group (n = 35)	P value
PACU admission	0 (0, 1)	1 (0, 2)	0.0673
POD 1	4 (3, 5)	3 (2, 4)	0.3085
POD 2	3 (2, 4)	3 (2, 3)	0.1015
POD 3	2 (1, 3)	2 (1, 2)	0.2223
POD 5	1.5 (0.75, 2.25)	1 (1, 2)	0.4077

Data are presented as median (IQR)

VAS visual analog scale

Table 5.

Postoperative analgesia and adverse reactions

	Control group (n = 34)	Esketamine group (n = 35)	P value
Number of PCIA button presses	9.32 ± 6.48	6.54 ± 4.39	0.040
Dosage of opioid analgesics postoperatively (mg)	114.9 ± 23.32	100.9 ± 25.72	0.021
Diziness
No	33 (97.1)	31 (88.6)
Yes	1 (2.9)	4 (11.4)	0.371
Nausea
No	28 (82.4)	27 (77.1)
Yes	6 (17.6)	8 (22.9)	0.591
Vomiting
No	34 (100)	33 (94.3)
Yes	0 (0)	2 (5.7)	0.486
Nightmares
No	34(100)	35(100)
Yes	0(0)	0(0)	1
Dissociation
No	34(100)	35(100)
Yes	0(0)	0(0)	1
Length of hospital stay (days)	20 (16,23)	18 (15,22)	0.442

Data are presented as mean ± SD, median (IQR), or number (percent)

PCIA patient-controlled analgesia

Perioperative blood biomarkers

The results revealed no statistically significant differences in the 5-HT or BDNF levels between the two groups at any time point (Fig. 2A and B). However, the plasma concentration of IL-6 in the esketamine group on POD 1 was significantly lower than that in the control group (P = 0.009). No significant differences were observed in the IL-6 concentrations between the two groups preoperatively or on PODs 3 and 5 (Fig. 2C). In contrast, the TNF-α concentration in the esketamine group on POD 5 was significantly lower than that in the control group (P = 0.011), whereas no significant differences in TNF-α concentrations between the two groups were observed at any other time points (Fig. 2D).

Fig. 2.

Blood biomarkers. A The concentration of 5-HT. B The concentration of BDNF. C The concentration of IL-6. D The concentration of TNF-α. Data are presented as mean ± SD. Blood samples were collected from 30 control group patients and 25 esketamine group patients. *P < 0.05

Adverse events and one-year survival rates

The incidence of postoperative adverse events, such as nausea, vomiting, and dizziness, did not significantly differ between the two groups. None of the patients developed nightmares or dissociation postoperatively (Table 5). Furthermore, the total hospitalization duration did not differ significantly between the two groups. The survival analysis revealed no significant difference in the one-year survival rate between the groups (Fig. 3).

Fig. 3.

The one-year survival rate of patients

Discussion

PD is a highly complex and invasive surgical intervention that often results in significant psychological and physiological trauma. It increases not only postoperative pain levels but also the incidence of postoperative depression. Our study revealed that while the use of PCIA to deliver continuous infusions of esketamine did not reduce the incidence of postoperative depression, it decreased the consumption of postoperative analgesics. Thus, esketamine represents a novel option for postoperative pain management in patients undergoing related major surgical procedures.

In recent years, many studies have investigated the effects of perioperative esketamine administration on postoperative pain management (Wang et al. 2021). In this work, a protocol of 1.5 mg/kg esketamine combined with 2 µg/kg sufentanil was established through preliminary studies, with the goal of providing patients with a more effective analgesic approach. Although our findings indicated that there were no statistically significant differences in VAS scores between the two groups, compared with the control group, the esketamine group demonstrated fewer PCIA button presses and used less analgesics. Furthermore, recent studies corroborate our findings, indicating that esketamine significantly alleviates postoperative pain in surgical patients (Ma et al. 2023; Yan et al. 2023; Qu et al. 2025).

However, no significant difference in the incidence of postoperative depression was observed between the two groups. Esketamine, which is the S(+) enantiomer of ketamine, exerts its anesthetic effects primarily by inhibiting NMDA receptors (Orser et al. 1997). Additionally, it may provide neuroprotective benefits through various mechanisms, including reducing inflammatory responses (Liu et al. 2016; Zhao et al. 2020). Furthermore, esketamine plays a clinical role in mitigating the prevalence of perioperative neurocognitive disorders (Luo et al. 2024; Ma et al. 2023; Hung et al. 2025). As an FDA-approved rapid-acting antidepressant, esketamine has been widely employed in perioperative anesthesia to investigate its effects on postoperative depression (Kim et al. 2019). For example, Sen et al. (2025) reported that the combination of sufentanil and esketamine in postoperative analgesia significantly reduced depressive symptoms in patients. Similarly, Wang et al. (2025) confirmed that the intraoperative infusion of esketamine could decrease the severity of depression in obstetric patients. These results are not inconsistent with the primary findings of our study. Nevertheless, the administration mode and dosage of esketamine markedly affect its therapeutic effects. For example, Shen et al. reported that a single administration of 0.25 mg/kg of ketamine failed to reduce the incidence of postoperative depression (Shen et al. 2022). However, Wang et al. demonstrated that continuous postoperative infusions of ketamine at doses of 0.2 mg/kg and 0.4 mg/kg effectively decreased the incidence of postoperative depression (Wang et al. 2022). Moreover, Min et al. demonstrated that 2.5 mg/kg of esketamine effectively decreased the incidence of postoperative depression among elderly patients (Min et al. 2023). These results confirm that the continuous postoperative administration of ketamine represents a favorable approach for improving postoperative depression. Therefore, a continuous postoperative administration method was adopted in this study.

Considering the number of participants and their baseline characteristics, we further analyzed postoperative depression scores. The difference in the HAMD-17 scores on the third postoperative day compared with the preoperative scores was greater in the esketamine group than in the control group, although this difference was not significant. However, by POD 5, the score change significantly differed between the two groups. These findings suggest that esketamine may improve depressive symptoms to some extent in patients following PD.

The mechanisms underlying postoperative depression remain unclear. Some studies have indicated that decreases in the levels of monoamine neurotransmitters, such as 5-HT, are closely associated with the onset of depression (Yamanaka et al. 2014). Additionally, the level of BDNF, the most abundant neurotrophic factor in the brain, has been shown to be reduced in individuals with depression (Rodrigues et al. 2024). Moreover, significant correlations between elevated concentrations of proinflammatory cytokines in peripheral circulation and the occurrence of depression have been reported (Cui et al. 2019; Liu et al. 2022).

In this study, we collected peripheral blood samples from patients to investigate the effects of esketamine on 5-HT, BDNF, IL-6, and TNF-α levels. The results demonstrated that esketamine did not decrease the expression levels of 5-HT or BDNF. However, the levels of the proinflammatory cytokines IL-6 and TNF-α were reduced on postoperative days one and five in the esketamine group. Yang et al. reported that IL-6 may serve as a biomarker for evaluating the antidepressant effect of ketamine (Yang et al. 2015). In the present study, preoperative IL-6 concentrations were measured and used as baseline values. However, the preoperative IL-6 levels did not differ significantly between the esketamine and control groups. The differences in the postoperative IL-6 levels between the two groups were consistent with the differences in the postoperative HAMD-17 scores, which supports the findings of Yang et al. that IL-6 levels are correlated with depressive status. These results suggest that while esketamine may not directly increase the levels of serotonin and BDNF, its role in reducing the levels of inflammatory markers could contribute to the observed improvements in postoperative depression and pain. However, further research is needed to explore the underlying mechanisms through which esketamine interacts with the complex neurobiological factors involved in depression.

Herein, we aimed to investigate the safety of the postoperative administration of esketamine by observing the incidence of postoperative adverse reactions and survival rates among different patient groups. The incidence of postoperative nausea, vomiting, and dizziness did not differ significantly between the esketamine and control groups. Furthermore, the use of esketamine did not reduce the hospitalization duration or affect the one-year survival rates of patients. These findings suggest that the incorporation of esketamine into postoperative analgesia protocols is safe. In recent years, many anesthesiologists have employed esketamine in perioperative settings. Moreover, no nightmares or dissociation symptoms were observed in any patients in the esketamine group, demonstrating that the administration mode and dosage of esketamine in this trial did not increase the incidence of postoperative ketamine-related adverse events. Thus, the perioperative use of esketamine represents a safe and effective therapeutic approach. However, further large-scale studies are warranted to validate the efficacy of esketamine in improving patient outcomes.

However, this study has some limitations that should be considered. First, the relatively small sample size may account for the nonsignificant findings regarding postoperative depression rates. Therefore, further multicenter clinical trials with larger sample sizes should be conducted to validate the effect of esketamine on postoperative depression. Second, the optimal dosage of esketamine in the PCIA should be further clarified. Our preliminary experiments indicated that a dosage of 1.5 mg/kg of esketamine effectively alleviated postoperative pain; however, owing to the limited sample size of these initial trials, larger-scale clinical studies should be conducted to determine the appropriate dosing regimen for esketamine.

Conclusion

In conclusion, this study demonstrated that the addition of esketamine to postoperative PCIA effectively reduced the use of opioid medications in patients who underwent PD. Furthermore, the addition of esketamine alleviated postoperative inflammation and exerted potential antidepressant effects. These findings provide new insights for anesthesiologists in terms of effectively managing pain and mitigating adverse emotional outcomes in patients following PD.

Abbreviations

PD

Pancreatoduodenectomy

NMDA

N-methyl-D-aspartate

IL-6

Interleukin-6

TNF-α

Tumor necrosis factor alpha

BDNF

Brain-derived neurotrophic factor

5-HT

5-Hydroxytryptamin

ASA

American Society of Anesthesiologists

SpO₂

Pulse oximetry

ECG

Electrocardiography

NIBP

Noninvasive blood pressure

IABP

Invasive arterial blood pressure

BIS

Bispectral index

PACU

Post-anesthesia care unit

PCIA

Intravenous patient-controlled analgesia

HAMD-17

Hamilton Depression Scale

VAS

Visual analog scale

BMI

Body mass index

POD

Postoperative day

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by K.Y., Q.P., S.G., M.Z., R.J., Y.W., Q.M. and Y.M.. The first draft of the manuscript was written by Z.W. and B.Z.. All authors commented on previous versions of the manuscript. D.M. and Y.Y. contributed to the study supervision and manuscript review. All authors read and approved the final manuscript.

Funding

This study is supported by the China Zhongguancun Precision Medicine and technology foundation (320.21.2022.01.45), Technology Development Fund of Tianjin Education Commission for Higher Education (2022ZD063), and Tianjin Key Medical Discipline Construction Project (Grant No.TJYXZDXK-3-003A).

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This trial received approval from the hospital’s Clinical Research Ethics Committee (E20221148). All participants provided written informed consent prior to enrollment.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.