Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery

被引:13
作者
Tang, Victoria L. [1 ,2 ]
Cenzer, Irena [1 ]
McCulloch, Charles E. [3 ]
Finlayson, Emily [4 ,5 ]
Cooper, Zara [6 ,7 ]
Silvestrini, Molly [1 ]
Ngo, Sarah [1 ]
Schmitt, Eva M. [8 ]
Inouye, Sharon K. [8 ,9 ,10 ]
机构
[1] Univ Calif San Francisco, Dept Med, Div Geriatr, 4150 Clement St,181 G, San Francisco, CA 94121 USA
[2] Vet Affairs Med Ctr, Dept Med, Div Hosp Med, San Francisco, CA 94121 USA
[3] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA
[4] Univ Calif San Francisco, Dept Surg, San Francisco, CA USA
[5] Univ Calif San Francisco, Phillip R Lee Inst Hlth Policy Studies, San Francisco, CA 94143 USA
[6] Brigham & Womens Hosp, Ctr Surg & Publ Hlth, 75 Francis St, Boston, MA 02115 USA
[7] Brigham & Womens Hosp, Dept Surg, 75 Francis St, Boston, MA 02115 USA
[8] Hebrew SeniorLife, Marcus Inst Aging Res, Aging Brain Ctr, Boston, MA USA
[9] Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA
[10] Harvard Med Sch, Boston, MA 02115 USA
关键词
depression; surgery outcomes; functional recovery; older adults; PROBLEM-SOLVING THERAPY; MAJOR DEPRESSION; SURGICAL OUTCOMES; OLDER-ADULTS; RISK-FACTOR; MORTALITY; FRAILTY; MORBIDITY; PREDICTOR; PATIENT;
D O I
10.1111/jgs.16781
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
BACKGROUND/OBJECTIVES Depression screening and treatment for older adults are recommended in Age-Friendly Health Systems. Few studies have evaluated the association between depressive symptoms and postoperative functioning. We aimed to determine the association between varying levels of depressive symptoms in the preoperative setting with postoperative functional recovery. DESIGN Prospective cohort study. SETTING Two academic hospitals in Boston, Massachusetts. PARTICIPANTS Surgical patients aged 70 and older (N = 560). MEASUREMENTS Participants were assessed preoperatively and 1 year postoperatively. Preoperative evaluation included the 15-item short-form Geriatric Depression Scale (GDS). Results were categorized as low (GDS = 0-1), moderate (2-5), or high (6-15) symptom burden. Primary outcome was 1-year instrumental activities of daily living functional decline. Secondary outcomes included hospital stay longer than 5 days, discharge to post-acute care (PAC) facility, and readmission within 30 days. RESULTS Mean participant age was 76.6 +/- 5 years, 58% were women, 81% underwent an orthopedic operation, 13% gastrointestinal, 6% vascular; 13% had functional decline at 1 year after their operation (by symptom burden: low = 5.5%; moderate = 14.8%, and high = 38.6%). After adjusting for age, sex, and comorbidity, those with moderate or high depressive symptoms demonstrated greater odds of functional decline at 1 year compared with those with a low symptom burden (moderate: adjusted odds ratio [AOR] = 2.7; 95% confidence interval [CI] = 1.3-5.3; high: AOR = 9.3; 95% CI = 4.2-20.6), discharge to PAC facility (moderate: AOR = 1.7; 95%CI = 1.2-2.6; high: AOR = 2.7; 95% CI = 1.4-5.1) but demonstrated no significant association with 30-day readmission or hospital length of stay longer than 5 days. CONCLUSION Greater burden of preoperative depressive symptoms is associated with increased likelihood of functional decline at 1 year after surgery and of discharge to PAC facility. Preoperative assessment of the burden of depressive symptoms in older adults undergoing elective surgery may be helpful in identifying patients at high risk of poor outcomes.
引用
收藏
页码:2814 / 2821
页数:8
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