Postoperative anxiety and depression symptoms in Chinese elderly patients: A multicenter observational study

Objective The postoperative mental health of elderly patients in China has received insufficient attention in the literature. Moreover, the population-based data on postoperative anxiety and depression symptoms among this population remain unavailable. We thus aimed to explore the prevalence, correlates, and clinical outcomes of these postoperative symptoms in this population in China. Methods This was a multicenter retrospective observational study, and it included individuals aged 65 and above in China who underwent non-cardiac surgery between April 1, 2020, and April 30, 2022. Anxiety and depression symptoms were assessed using the generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9), respectively. The primary analysis estimated the prevalence of these symptoms. For exploratory analyses, mixed-effects logistic regression models with study center as a random intercept were used to identify the factors independently associated with psychological symptoms and to examine their associations with clinical outcomes, with covariates selected a priori based on clinical knowledge. Results In total, 7568 patients (median age: 71 [IQR 68–74] years; 56.4% male) were included in the final analysis. Postoperative anxiety symptoms were present in 1671 patients (22.08%) and depression symptoms in 1788 (23.63%). The highest prevalence of anxiety was observed in plastic and other surgeries, while the highest prevalence of depression occurred in gastrointestinal surgery. The factors independently associated with higher odds of both anxiety and depression symptoms included a history of malignant tumor and preoperative sleep disorder. Male sex, intraoperative dexmedetomidine, and intraoperative esketamine were independently associated with lower odds of both conditions. Regarding clinical outcomes, after adjusting for relevant confounders and center effects, anxiety symptoms were associated with higher odds of infectious complications and acute postoperative pain; depression symptoms were associated with higher odds of delirium and acute postoperative pain. Conclusions This study highlights that over one-fifth of elderly non-cardiac surgery patients experience postoperative anxiety and depression symptoms, thus emphasizing the critical need for clinicians to address this significant mental health burden and its underlying contributors.