Anxiety and depression in non-cardiac surgical patients and associations with adverse outcomes: A systematic review and meta-analysis

Figures

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  Fig. 1. PRISMA 2020 Study Selection Flow Diagram. Identification of studies via databases/registers and other methods.

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  Fig. 2. Forest plot of pooled prevalence of preoperative anxiety (HADS-A ≥ 7/8) in surgical patients overall (A) and by surgery type (B). Note: Between-study variability may reflect differences in cut-off points and types of surgeries. Variation across surgical subgroups may reflect procedure-specific patient characteristics and recovery profiles. HADS-A; Hospital Anxiety and Depression Scale-Anxiety. Mixed surgery: it includes a combination of general, cancer, thyroid, orthopedic, breast, thoracic, abdominal, gynecological, urological, vascular, and other surgery types.

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  Fig. 3. Forest plot of pooled prevalence of preoperative depression in surgical patients overall (A) and by surgery type (B). Variation in prevalence estimates may arise from heterogeneity in different depression screening tools, scoring thresholds, and types of surgery. Variation across surgical subgroups may reflect procedure-specific patient characteristics and recovery profiles as well as differences in depression screening tools. Mixed surgery: it includes a combination of general, cancer, thyroid, orthopedic, breast, thoracic, abdominal, gynecological, urological, vascular, and other surgery types.

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  Fig. 4. Forest plot of pooled prevalence of depression using validated screening tools (HADS-D ≥ 8, GDS ≥ 5/6, PHQ ≥ 9, CES-D ≥ 16). Differences between subgroups highlight how instrument choice and cut points may influence pooled estimates. Variation may also reflect heterogeneity in surgery types utilizing each tool. HADS-D: Hospital Anxiety and Depression Scale-Depression (cutoff = 8); GDS: Geriatric Depression Scale (= 5/6); CES-D: Center for Epidemiological Studies-Depression (= 16); PHQ: Patient Health Questionnaire (= 9). Surgeries include orthopedic, mixed and cancer. Mixed surgery: it includes a combination of general, cancer, thyroid, orthopedic, breast, thoracic, abdominal, gynecological, urological, vascular, and other surgery types.

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  Fig. 5. Overall pooled prevalence of preoperative anxiety (A) and depression (B) by type of surgery. Mixed surgery: it includes a combination of general, cancer, thyroid, orthopedic, breast, thoracic, abdominal, gynecological, urological, vascular, and other surgery types.

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  Fig. 6. Associations between preoperative anxiety (A) and depression (B) and postoperative outcomes.