Influence of Depression on Recovery After Major Noncardiac Surgery

OBJECTIVES: To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it. BACKGROUND: Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model of postoperative outcome considers this dimension. METHODS: This prospective multicenter study included patients undergoing liver resections, a model of major abdominal surgery, between September 2013 and September 2014 in 8 centers. The primary outcome was postoperative morbidity or mortality (assessed by the Clavien-Dindo grade and the Comprehensive Complication Index) and the postoperative length of stay (LOS). Depression and anxiety were assessed preoperatively with the Hospital Anxiety and Depression Scale and a validated cutoff. Surgeons were preoperatively asked to predict outcome. Multivariable mixed-effects Cox models were fitted to evaluate the influence of depression on actual and surgeon-anticipated outcome and on the difference between actual and surgeon-anticipated LOS. RESULTS: Hospital Anxiety and Depression Scale identified 142 of 591 patients (24.0%) as depressed and 40.3% as anxious. Neither condition was independently correlated with morbidity or mortality, but depression was an independent risk factor for prolonged LOS (adjusted hazard ratio 0.65, 95% confidence interval 0.50-0.83, P = 0.001). Depression was not correlated with anticipated LOS. Three variables explained the gap between anticipated and actual LOS: depression (P = 0.003), associated surgical procedures in addition to liver resection (P = 0.007), and postoperative morbidity (P < 0.001). CONCLUSIONS: Nearly 1 quarter of patients undergoing major abdominal surgery are depressed preoperatively. This depression is a strong independent predictor of prolonged LOS and partly explains surgeons' failure to predict outcome accurately.