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Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery
Author(s) -
Tang Victoria L.,
Cenzer Irena,
McCulloch Charles E.,
Finlayson Emily,
Cooper Zara,
Silvestrini Molly,
Ngo Sarah,
Schmitt Eva M.,
Inouye Sharon K.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16781
Subject(s) - medicine , depression (economics) , odds ratio , comorbidity , confidence interval , geriatric depression scale , prospective cohort study , orthopedic surgery , cohort study , physical therapy , geriatrics , cohort , activities of daily living , surgery , depressive symptoms , anxiety , psychiatry , economics , macroeconomics
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.