Background <p>This study aims to identify the influencing factors of preoperative anxiety and depression and their impact on postoperative outcomes in pulmonary nodules (PN) patients.</p> Methods <p>The sampling method of this cross-sectional study was convenience sampling. This study enrolled 311 patients who underwent surgery for PNs at Nanjing Drum Tower Hospital from Jul 2025 to Aug 2025. Generalized linear regression was used to explore the influencing factors of preoperative depression and anxiety, and the Generalized Estimating Equation (GEE) model to measure changes in depression and anxiety at three time points, as well as the impact of preoperative depression and anxiety on postoperative pain, cough, and cough frequency.</p> Results <p>Three hundred eleven patients with PNs were included, consisting of 117 males (37.6%) and 194 females (62.4%), with a median age of 57.00 (50.00–63.00) years. The prevalence rates of preoperative depression and anxiety were both 5.5% (both <i>N</i> = 17). Being female, having a high school education, and undergoing lobectomy were identified as influencing factors of preoperative depression. Being female, belonging to other ethnicities, and having pain were influencing factors of preoperative anxiety. The depression scores showed a trend of first increasing and then decreasing, while the anxiety scores showed a gradual downward trend. Preoperative anxiety was a risk factor for pain on the second postoperative day. In addition, preoperative depression was a risk factor for cough frequency on the 30th postoperative day.</p> Conclusions <p>Anxiety and depression were common psychological disorders in patients with PNs before surgery. Preoperative anxiety and depression can affect postoperative prognosis.</p>