术前抑郁症状与术后功能恢复不良相关。
Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery.
机构信息
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA.
出版信息
J Am Geriatr Soc. 2020 Dec;68(12):2814-2821. doi: 10.1111/jgs.16781. Epub 2020 Sep 8.
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.
背景/目的：老年人的抑郁筛查和治疗在老年友善卫生系统中得到推荐。很少有研究评估术前抑郁症状与术后功能之间的关系。我们旨在确定术前不同程度的抑郁症状与术后功能恢复之间的关系。
设计
前瞻性队列研究。
地点
马萨诸塞州波士顿的两家学术医院。
参与者
年龄在 70 岁及以上的手术患者（N=560）。
测量
参与者在术前和术后 1 年进行评估。术前评估包括 15 项简短老年抑郁量表（GDS）。结果分为低（GDS=0-1）、中（2-5）或高（6-15）症状负担。主要结局是术后 1 年工具性日常生活活动功能下降。次要结局包括住院时间超过 5 天、出院到康复机构和术后 30 天内再入院。
结果
平均参与者年龄为 76.6±5 岁，58%为女性，81%接受了骨科手术，13%为胃肠道手术，6%为血管手术；13%的患者在术后 1 年出现功能下降（按症状负担：低=5.5%；中=14.8%，高=38.6%）。在调整年龄、性别和合并症后，与低症状负担者相比，中或高抑郁症状者在 1 年时功能下降的可能性更大（中：调整后的优势比[OR]为 2.7；95%置信区间[CI]为 1.3-5.3；高：OR 为 9.3；95%CI 为 4.2-20.6），出院到康复机构（中：OR 为 1.7；95%CI 为 1.2-2.6；高：OR 为 2.7；95%CI 为 1.4-5.1），但与术后 30 天再入院或住院时间超过 5 天无显著关联。
结论
术前抑郁症状负担增加与术后 1 年功能下降和出院到康复机构的可能性增加相关。对接受择期手术的老年患者术前抑郁症状负担进行评估，可能有助于识别预后不良风险较高的患者。
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