目的:抑郁症是长期残疾和术前心理健康状态的常见原因,对优化围手术期的恢复具有重要意义。在老年择期手术患者中,术前抑郁的患病率以及相关的不良术前和术后结局尚不清楚.本系统评价和荟萃分析旨在确定老年手术人群术前抑郁的患病率和相关的不良结局。
方法:系统评价和荟萃分析。
方法:MEDLINE,MEDLINEEpub在打印和处理之前,数据审查和其他非索引引文,Embase/EmbaseClassic,科克伦中部,和Cochrane系统评价数据库,临床试验。政府,2000年至今的相关文章的WHOICTRP(国际临床试验注册平台)。
方法:年龄≥65岁接受非心脏择期手术的患者,通过在老年人中验证的工具评估术前抑郁。这些经过验证的工具包括老年抑郁量表(GDS),医院抑郁和焦虑量表(HADS),贝克抑郁量表-II(BDI),患者健康问卷-9(PHQ-9),和流行病学研究中心抑郁量表(CESD)。
方法:术前评估。
方法:主要结果是术前抑郁的患病率。其他结果包括术前认知障碍,术后结果如谵妄,功能衰退,放电处理,重新接纳,逗留时间,术后并发症。
结果:共纳入13项研究(n=2824)。使用老年抑郁量表15(GDS-15)(n=12)评估术前抑郁。术前抑郁的总患病率为23%(95%CI:15%,30%)。在非癌症非心脏混合手术中,合并患病率为19%(95%CI:11%,27%)。骨科手术的患病率为17%(95%CI:9%,24%)。在脊柱手术中,患病率更高,为46%(95%CI:28%,64%)。Meta分析显示,术前抑郁与术后谵妄的风险比无抑郁者增加两倍(32%vs23%,OR:2.25;95%CI:1.67,3.03;I2:0%;P≤0.00001)。
结论:患有抑郁症的老年手术患者的总体患病率为23%。术前抑郁与术后谵妄风险高2倍相关。需要进一步的工作来确定术前抑郁症筛查和治疗的必要性。
OBJECTIVE: Depression is a common cause of long-lasting disability and preoperative mental health state that has important implications for optimizing recovery in the perioperative period. In older elective surgical patients, the prevalence of preoperative depression and associated adverse pre- and postoperative outcomes are unknown. This systematic
review and meta-analysis aimed to determine the prevalence of preoperative
depression and the associated adverse outcomes in the older surgical population.
METHODS: Systematic
review and meta-analysis.
METHODS: MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-
Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) for relevant articles from 2000 to present.
METHODS: Patients aged ≥65 years old undergoing non-cardiac elective surgery with preoperative depression assessed by tools validated in older adults. These validated tools include the Geriatric
Depression Scale (GDS), Hospital
Depression and Anxiety Scale (HADS), Beck Depression Inventory-II (BDI), Patient Health Questionnaire-9 (PHQ-9), and the Centre for Epidemiological Studies Depression Scale (CESD).
METHODS: Preoperative assessment.
METHODS: The primary outcome was the prevalence of preoperative depression. Additional outcomes included preoperative cognitive impairment, and postoperative outcomes such as delirium, functional decline, discharge disposition, readmission, length of stay, and postoperative complications.
RESULTS: Thirteen studies (n = 2824) were included. Preoperative
depression was most assessed using the Geriatric
Depression Scale-15 (GDS-15) (n = 12). The overall prevalence of preoperative depression was 23% (95% CI: 15%, 30%). Within non-cancer non-cardiac mixed surgery, the pooled prevalence was 19% (95% CI: 11%, 27%). The prevalence in orthopedic surgery was 17% (95% CI: 9%, 24%). In spine surgery, the prevalence was higher at 46% (95% CI: 28%, 64%). Meta-analysis showed that preoperative depression was associated with a two-fold increased risk of postoperative delirium than those without depression (32% vs 23%, OR: 2.25; 95% CI: 1.67, 3.03; I2: 0%; P ≤0.00001).
CONCLUSIONS: The overall prevalence of older surgical patients who suffered from depression was 23%. Preoperative depression was associated with a two-fold higher risk of postoperative delirium. Further work is needed to determine the need for depression screening and treatment preoperatively.