Preoperative Depressive Symptoms Associated with Poor Functional Recovery after Surgery.
Activities of Daily Living
Aged
Boston
Comorbidity
Depression
/ diagnosis
Elective Surgical Procedures
Female
Humans
Male
Massachusetts
Orthopedic Procedures
Patient Discharge
/ statistics & numerical data
Patient Readmission
/ statistics & numerical data
Postoperative Period
Preoperative Care
Prospective Studies
Recovery of Function
depression
functional recovery
older adults
surgery outcomes
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
05
03
2020
revised:
24
06
2020
accepted:
16
07
2020
pubmed:
9
9
2020
medline:
19
3
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
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. Prospective cohort study. Two academic hospitals in Boston, Massachusetts. Surgical patients aged 70 and older (N = 560). 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32898280
doi: 10.1111/jgs.16781
pmc: PMC7744402
mid: NIHMS1630236
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2814-2821Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001870
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG056342
Pays : United States
Organisme : NIA NIH HHS
ID : R01 AG044518
Pays : United States
Organisme : NIA NIH HHS
ID : K76 AG059931
Pays : United States
Organisme : NIA NIH HHS
ID : R01AG044518
Pays : United States
Organisme : NIA NIH HHS
ID : K07 AG041835
Pays : United States
Organisme : NIA NIH HHS
ID : K07AG041835
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG031720
Pays : United States
Organisme : NIH HHS
ID : KL2TR001870
Pays : United States
Organisme : NIH HHS
ID : P30AG044281
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG044281
Pays : United States
Organisme : NIA NIH HHS
ID : R24AG054259
Pays : United States
Organisme : NIA NIH HHS
ID : R24 AG054259
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG056342
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG066605
Pays : United States
Informations de copyright
© 2020 The American Geriatrics Society.
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