Study: Depressive symptoms may be a modifiable factor to improve surgical outcomes
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Key takeaways:
- Preoperative depressive symptom burden treatment may improve patient outcomes and depression trajectories after surgery.
- Early intervention should focus on depressive symptoms and enhancing physical function.
According to published results, preoperative depressive symptom burden treatment may improve patient-centered outcomes and health trajectories after surgery.
Irena Cenzer, PhD, and colleagues for the Successful Aging after Elective Surgery study performed a prospective cohort study of 487 patients (mean age of 76.5 years) who underwent orthopedic, gastrointestinal or vascular surgery between June 8, 2010, and Aug. 8, 2013.
According to the study, the primary outcome measure was number of depressive symptoms, as recorded on the 15-item Geriatric Depression Scale (GDS). Researchers collected outcomes before surgery and at 6, 12 and 18 months postoperatively.
Researchers found 31% of patients (n = 150) had a sustained low depressive symptom trajectory, 59% (n = 290) had a sustained moderate depressive symptom trajectory and 10% (n = 47) had a sustained high depressive symptom trajectory.
Overall, mean preoperative GDS score was 2.4. Among all patients, GDS scores improved 0.46 points in the first 6 months but did not change during the subsequent year.
Researchers noted patients with sustained low and moderate depression trajectories had a “statistically significant but small improvement” in GDS scores immediately after surgery; however, no improvements were seen in the subsequent year. Patients with sustained high depression trajectories had no significant improvements in GDS scores during the entire 18-month postoperative period.
“Our results underscore opportunities for screening older surgical patients and providing early intervention focused on both depressive symptom burden treatment and enhancing physical functioning,” the researchers wrote in the study.
Perspective
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In this article, Irena Cenzer, PhD, and colleagues evaluated the trajectories of depressive symptoms in patients aged at least 70 years old undergoing major elective surgery. They demonstrated no significant changes in depressive symptoms among older adults up to 18 months after surgery. Moreover, they found postoperative depressive symptoms were significantly associated with preoperative depression and functional dependence.
This subject is timely and of great interest as depression and/or depression symptoms have been identified as a modifiable risk factor in patients undergoing orthopedic procedures, specifically total joint arthroplasty. Depression and low mental health scores have been shown to improve in patients after arthroplasty procedures. However, it appears these patients are at increased risk for complications and revision surgery. The importance of preoperative optimization in this patient population has proven to be advantageous.
In summary, this study raises awareness. There is a complex interplay between depression, types of depression and other underlying mental health disorders within this spectrum that may be detrimental to outcomes following elective orthopedic surgery procedures. Further research is needed to delineate between acute and chronic, as well as treated vs. untreated depression, before definitive conclusions and recommendations can be made.
References:
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Halawi MJ, et al. J Arthroplasty. 2019;doi:10.1016/j.arth.2019.03.063.
Harmer JR, et al. Bone Joint J. 2023;doi:10.1302/0301-620X.105B5.BJJ-2022-1123.R1.
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