Takagi Hisato, Ando Tomo, Umemoto Takuya
Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan.
Department of Cardiology, Detroit Medical Center, Detroit, MI, USA.
Heart Vessels. 2017 Dec;32(12):1458-1468. doi: 10.1007/s00380-017-1022-3. Epub 2017 Jul 13.
We performed a systematic review and meta-analysis to determine whether perioperative depression and anxiety are associated with increased postoperative mortality in patients undergoing cardiac surgery. MEDLINE and EMBASE were searched through January 2017 using PubMed and OVID, to identify observational studies enrolling patients undergoing cardiac surgery and reporting relative risk estimates (RREs) (including odds, hazard, or mortality ratios) of short term (30 days or in-hospital) and/or late all-cause mortality for patients with versus without perioperative depression or anxiety. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic RREs in the random-effects models. Our search identified 16 eligible studies. In total, the present meta-analysis included data on 236,595 patients undergoing cardiac surgery. Pooled analysis demonstrated that perioperative depression was significantly associated with increased both postoperative early (RRE, 1.44; 95% confidence interval [CI] 1.01-2.05; p = 0.05) and late mortality (RRE, 1.44; 95% CI 1.24-1.67; p < 0.0001), and that perioperative anxiety significantly correlated with increased postoperative late mortality (RRE, 1.81; 95% CI 1.20-2.72; p = 0.004). The relation between anxiety and early mortality was reported in only one study and not statistically significant. In the association of depression with late mortality, there was no evidence of significant publication bias and meta-regression indicated that the effects of depression are not modulated by the duration of follow-up. In conclusion, perioperative depression and anxiety may be associated with increased postoperative mortality in patients undergoing cardiac surgery.
我们进行了一项系统评价和荟萃分析，以确定围手术期抑郁和焦虑是否与心脏手术患者术后死亡率增加相关。通过PubMed和OVID检索截至2017年1月的MEDLINE和EMBASE，以识别纳入心脏手术患者的观察性研究，并报告有或无围手术期抑郁或焦虑患者的短期（30天或住院期间）和/或晚期全因死亡率的相对风险估计值（RREs）（包括比值比、风险比或死亡率比）。在随机效应模型中，使用对数RREs的逆方差加权平均值合并研究特异性估计值。我们的检索确定了16项符合条件的研究。本荟萃分析总共纳入了236,595例接受心脏手术患者的数据。汇总分析表明，围手术期抑郁与术后早期死亡率增加（RRE，1.44；95%置信区间[CI]1.01 - 2.05；p = 0.05）和晚期死亡率增加均显著相关（RRE，1.44；95% CI 1.24 - 1.67；p < 0.0001），围手术期焦虑与术后晚期死亡率增加显著相关（RRE，1.81；95% CI 1.20 - 2.72；p = 0.004）。仅一项研究报告了焦虑与早期死亡率之间的关系，且无统计学意义。在抑郁与晚期死亡率的关联中，没有证据表明存在显著的发表偏倚，荟萃回归表明抑郁的影响不受随访时间的调节。总之，围手术期抑郁和焦虑可能与心脏手术患者术后死亡率增加有关。
