Objective To explore the association between severe postoperative complications after emergency surgery and mental distress among operating surgeons, and to identify the related factors.

Methods This cross-sectional survey was conducted from January 2024 to December 2025. Anonymous questionnaires were administered using a convenience sampling method to operating surgeons who had experienced severe postoperative complications after emergency surgery (Clavien-Dindo grade ≥Ⅲ), and the incidence rate of mental suffering was calculated. Related factors were analyzed using the χ² test, trend test, and multivariable logistic regression.

Results A total of 216 operating surgeons who had experienced severe postoperative complications after emergency surgery were included, with an overall prevalence of mental distress of 74.07%. The positive screening rates for anxiety and depression increased significantly with increasing severity of mental distress (P＜0.001). Multivariable logistic regression showed that timing of complication onset was one of the factors most strongly associated with surgeons’ mental distress. Compared with complications occurring on postoperative days 1–3, complications occurring on postoperative days 4–7 were associated with a significantly higher risk of mental distress (OR=10.329, 95%CI 2.947–36.207, P＜0.001). In addition, experience of medical conflict (OR=2.062, 95%CI 1.015–4.187) and an external attribution style (OR=1.996, 95%CI 1.007–3.959) were also independently associated with mental distress (P＜0.05).

Conclusion Severe postoperative complications after emergency surgery are commonly accompanied by mental distress among operating surgeons, often with prominent symptoms of anxiety and depression. Influenced by multiple factors, including event characteristics, system responses, and individual cognition, postoperative 4–7 days may represent a critical high-risk window warranting particular attention.