Depression In Surgical Patients Research Articles

Investigating Relationships Between Pain, Comfort, Anxiety and Depression in Surgical Patients

Investigating Relationships Between Pain, Comfort, Anxiety and Depression in Surgical Patients

Effect of low-dose esketamine on pain control and postpartum depression after cesarean section: a retrospective cohort study.

Esketamine is used to control postoperative pain and reduce postoperative depression in surgical patients. This study was performed to determine the effects of esketamine on pain control as well as postpartum depression (PPD) in pregnant women who underwent cesarean section (CS). Pregnant women who underwent CS between March 2018 and February 2020 at our hospital were retrospectively reviewed. Parturients in the control group received 50 µg sufentanil citrate and 0.25 mg palonosetron hydrochloride, while those in the experimental group received additional 0.2-0.5 mg/kg esketamine. The primary outcomes included postoperative pain control according to the numeric rating scale (NRS) and the incidence of PPD according to the Edinburgh postnatal depression scale (EPDS). Multivariable linear regression analysis was performed to determine the relationship between the use of esketamine, pain control, and the incidence of PPD after CS. There were 132 parturients in the control group and 108 parturients in the esketamine group in this study. All NRS scores at rest at any time point were much lower in the esketamine group than those in the control group. Besides, NRS scores when coughing were also lower in the esketamine group within 24 hours. EPDS scores were lower in the esketamine group than those in the control group within 3 months postpartum. Esketamine acted as a protector of pain control and was confirmed to improve the incidence of PPD using multivariable linear regression. Parturients had dramatically better sleep quality within 1 week postpartum (P=0.044), and morphine consumption within 24 hours postpartum was lower in the esketamine group than in the control group (P<0.001). The quality of recovery within 3 months postpartum was also better in the esketamine group (P=0.001). A subgroup analysis of 2 subgroups divided according to the dose of esketamine was then performed, indicating no significant difference between the low-dose group and high-dose group in most included outcomes. This study confirmed the effects of esketamine on pain control and the incidence of PPD in pregnant women who underwent CS. Considering the potential adverse events, low-dose esketamine may be more suitable for pregnant women who have undergone CS.

Preoperative Assessment of Anxiety and Depression Using Computerized Adaptive Screening Tools: A Pilot Prospective Cohort Study.

Serious mental health conditions (eg, anxiety and depression) are common in surgical patients, yet likely underassessed due to the time-consuming and cumbersome traditional screening process. A recently developed computerized adaptive mental health assessment tool (computerized adaptive test-mental health [CAT-MH]) allows rapid, precise, and accurate assessment of numerous mental health disorders, including anxiety and depression, without the need for a trained interviewer. The goal of this investigation was to determine the feasibility of administering CAT-MH for anxiety and depression in the preoperative setting and to obtain preliminary evidence of the prevalence of anxiety and depression in preoperative patients. In this prospective cohort study, 100 adult patients scheduled for elective surgery were enrolled and asked to complete the CAT-MH in the preoperative clinic. Urgent and emergency surgeries were excluded as were pregnant patients. Primary feasibility outcomes were completion rate and time to completion. Secondary outcomes were prevalence estimates of anxiety and depression. All 100 enrolled patients completed the study. All patients were able to complete the mental health assessment (mean time: 3.6 ± 1.8 minutes standard deviation). Sixteen patients (16%) screened positive for anxiety (severity: mild, n = 7 [7%]; moderate, n = 7 [7%]); severe, n = 2 [2%]); 12 of 16 (75%) did not have a previous diagnosis of anxiety disorder. Twenty-eight (28%) patients screened positive for depression (severity: mild, n = 26 [26%]; moderate and severe, n = 1 each [1%]); 23 of 28 (82%) had no previous diagnosis of depressive disorder. Nineteen patients (19%) met the screening criteria for major depressive disorder; 14 of 19 (74%) of which had no previous diagnosis of major depressive disorder. The results of this pilot study support the feasibility of using CAT-MH in a preoperative evaluation and indicate that there is a substantial prevalence of undiagnosed anxiety and depression in surgical patients.

Opioids and obstructive sleep apnea.

Freire C, Sennes LU, Polotsky VY. Opioids and obstructive sleep apnea. J Clin Sleep Med. 2022;18(2):647-652.

Symptoms of anxiety and depression in surgical patients at the hospital, 6weeks and 6months postsurgery: A questionnaire study.

AimsTo describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3.DesignProspective, explorative two‐site follow‐up study.MethodsPatients having selected surgeries from January–July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression.ResultsThe proportion of patients presenting with moderate‐to‐severe anxiety or depression ranged from 5.4%–20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS‐Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS‐Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%–55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

Frequency of Depression and Anxiety Symptoms in Surgical Hospitalized Patients.

BackgroundPatients hospitalized for surgeries and those with chronic remitting health conditions develop hospital-induced anxiety and depression. Unfamiliar hospital environment, insufficient privacy, exposure to strange instruments, financial concerns, disease stress, and prolonged hospital stay contribute to this anxiety. The aim of this study was to assess the frequency of depression and anxiety in surgical patients.Material and methodsThis observational study was conducted among 50 patients hospitalized for 10 days or more in the surgical unit. All patients completed the Hospital Anxiety and Depression Scale (HADS). It has seven items for anxiety and depression each. Each item scores 0-3. A subscale score >8 denotes anxiety or depression. Data were entered and analyzed using SPSS v.20. Mean and standard deviation (SD) were calculated for descriptive data, and frequencies and percentages were calculated for categorical data.ResultsOn the HADS, the mean ± SD score of anxiety was 11.84 ± 4.16 and that of depression was 12.78 ± 4.16. There were 64% severely anxious and 74% severely depressed hospitalized patients. More patients with less than two weeks of hospital stay were severely depressed than severely anxious (72.7% vs. 36.3%). There were 20% patients with moderate anxiety and depression with hospital stay longer than three weeks and 80% with severe anxiety and depression.ConclusionThere is a high incidence of anxiety and depression in surgical patients. Patients at risk of developing these symptoms must be identified and psychological care should be provided to them.

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses

ObjectiveThis systematic review and meta-analysis aim to evaluate the risk factors associated with postoperative opioid-induced respiratory depression (OIRD).DesignSystematic review and meta-analysis.Data sourcesPubMed-MEDLINE, MEDLINE in-process, EMBASE, Cochrane Central Register of Controlled...

Obstructive Sleep Apnea Screening Among Surgical Patients: A Quality Improvement Project

Obstructive sleep apnea (OSA) increases the risk of respiratory depression in surgical patients. This project screened patients for OSA and explored its relationship with respiratory complications. Quality improvement project. Neurosurgical patients were preoperatively screened using STOP-Bang questionnaire scores of 5 or greater as high risk and less than 5 as low risk for moderate-to-severe OSA. Postoperative respiratory complications were compared between both OSA groups. Perioperative staff and patient education included an OSA care protocol using STOP-Bang screening. Of the 161 patients screened, 29.8% scored high risk for OSA, noting elevated end tidal CO2, increased oxygen desaturation, and required pulse oximetry with supplemental oxygen compared with the low-risk group (P<.05). Education improved nurses' awareness of OSA risks by 81%, and 87.5% of patients were satisfied with the OSA care protocol. The OSA care protocol decreased risk for postoperative respiratorycomplications. Education is essential for safer perioperative outcomes.

Depression and essential health risk factors in surgical patients in the preoperative anaesthesiological assessment clinic

Depression is common in patients with medical illness. However, little is known about frequency and clinical relevance of preoperative depression in surgical patients. The objective of this study was to investigate the frequency of depression, essential health risk factors and hospital length of stay (LOS) of patients in preoperative anaesthesiological assessment. Patients were consecutively screened in the preoperative anaesthesiological assessment clinics. In total, 5429 patients gave written informed consent to perform a computerised self-assessment of lifestyle factors, including alcohol use, tobacco smoking, weight, physical status, physical exercise, sleeping disturbance, subjective health and sense of coherence (SOC). Depression was defined by a WHO-5 well-being score of 13 or less. LOS was obtained from the electronic patient management system. A clinically relevant depressive state was found in 29.7% of the patients. Patients with depression had a median LOS of 6.0 days as compared to patients with positive well-being who had a LOS of 4.8 days (P < 0.001). Worse subjective health, less physical exercise and experience of SOC, as well as more severe sleeping disturbances were independently and significantly associated with depression (P < 0.001). Clinically significant depressive states are frequent conditions in surgical patients of preoperative anaesthesiological assessment and are associated with an increased LOS. Different clinical pathways delivering adequate preoperative information according to the needs, considering subjective health and SOC of the patient as well as avoiding immobilisation and sleep disturbances during hospital stay should be considered. Long-term treatment programmes including brief intervention in the hospital and an outpatient concept should be offered.

Surgical trauma and immunosuppression: pathophysiology and potential immunomodulatory approaches

Several studies indicate that organ failure is the leading cause of death in the postoperative phase after major surgery. An excessive inflammatory response followed by a dramatic depression of cell-mediated immunity after major surgery appears to be responsible for the increased susceptibility to subsequent sepsis. In view of this, most of the scientific and medical research has been directed towards measuring the progression and interrelationship of mediators after major surgery. Furthermore, the effect of those mediators on cell-mediated immune responses has been studied. This article focuses on the effect of surgical injury and blood loss on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock. The findings from those experimental studies will also be correlated with data from surgical patients. Recently, a gender-dimorphic immune and organ responsiveness in the susceptibility to and morbidity from shock, trauma, and sepsis has been found. Androgens have been shown to be responsible for the immunosuppression after trauma-hemorrhage in males. In contrast, female sex steroids exhibit immunoprotective properties after trauma and severe blood loss. In view of these findings, clinically relevant therapeutic strategies have been developed using the testosterone receptor blocker flutamide and/or estrogen or agents with estrogenic effects, i.e., dehydroepiandrosterone, which might yield safe and useful therapeutic approaches for the treatment of immune depression in surgical patients.

Anxiety and depression in surgical patients: a clinical report from an Italian general hospital.

Anxiety and depression in surgical patients: a clinical report from an Italian general hospital.