Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow Klinikum and Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany.
Eur J Anaesthesiol. 2011 Oct;28(10):733-41. doi: 10.1097/EJA.0b013e3283478361.
Depression is common in patients with medical illness. However, little is known about frequency and clinical relevance of preoperative depression in surgical patients. The objective of this study was to investigate the frequency of depression, essential health risk factors and hospital length of stay (LOS) of patients in preoperative anaesthesiological assessment.
Patients were consecutively screened in the preoperative anaesthesiological assessment clinics. In total, 5429 patients gave written informed consent to perform a computerised self-assessment of lifestyle factors, including alcohol use, tobacco smoking, weight, physical status, physical exercise, sleeping disturbance, subjective health and sense of coherence (SOC). Depression was defined by a WHO-5 well-being score of 13 or less. LOS was obtained from the electronic patient management system.
A clinically relevant depressive state was found in 29.7% of the patients. Patients with depression had a median LOS of 6.0 days as compared to patients with positive well-being who had a LOS of 4.8 days (P < 0.001). Worse subjective health, less physical exercise and experience of SOC, as well as more severe sleeping disturbances were independently and significantly associated with depression (P < 0.001).
Clinically significant depressive states are frequent conditions in surgical patients of preoperative anaesthesiological assessment and are associated with an increased LOS. Different clinical pathways delivering adequate preoperative information according to the needs, considering subjective health and SOC of the patient as well as avoiding immobilisation and sleep disturbances during hospital stay should be considered. Long-term treatment programmes including brief intervention in the hospital and an outpatient concept should be offered.
抑郁在患有内科疾病的患者中很常见。然而，对于手术患者术前抑郁的频率和临床相关性知之甚少。本研究的目的是调查术前麻醉评估患者中抑郁的频率、基本健康风险因素和住院时间（LOS）。
患者在术前麻醉评估诊所中连续进行筛查。共有 5429 名患者书面同意进行生活方式因素的计算机自我评估，包括饮酒、吸烟、体重、身体状况、体育锻炼、睡眠障碍、主观健康和应对能力（SOC）。抑郁定义为 WHO-5 幸福感评分低于 13。LOS 从电子患者管理系统中获得。
发现 29.7%的患者存在临床相关的抑郁状态。与幸福感呈阳性的患者相比，患有抑郁症的患者的 LOS 中位数为 6.0 天，而幸福感呈阳性的患者的 LOS 中位数为 4.8 天（P<0.001）。较差的主观健康、较少的体育锻炼和 SOC 体验，以及更严重的睡眠障碍与抑郁独立且显著相关（P<0.001）。
在接受术前麻醉评估的外科患者中，临床上显著的抑郁状态是常见的，并与 LOS 增加有关。应考虑根据需要提供不同的临床途径，提供足够的术前信息，考虑患者的主观健康和 SOC，以及避免住院期间的固定和睡眠障碍。应提供包括在医院进行简短干预和门诊概念在内的长期治疗方案。
