Depression and anxiety among older surgical patients with cognitive impairment: a multicenter longitudinal cohort...

Cognitive impairment (CI), depression, and anxiety are underrecognized yet frequently co-existing conditions linked to poor surgical outcomes in older patients. We examined: 1) the prevalence and perioperative trajectory of depression/anxiety in patients with and without CI; 2) preoperative patient-reported outcome measures; and 3) postoperative outcomes associated with depression/anxiety.

This study included 369 surgical patients (≥65 years) from two academic tertiary care hospitals. CI was assessed with the Ascertain Dementia Eight preoperatively, while depression/anxiety was measured using the Patient Health Questionnaire-4 preoperatively, at 30-, and 90 days postoperatively. The trajectory of depression/anxiety in CI versus no-CI patients was analyzed with linear mixed-effects models.

Preoperatively, 28% of patients had depression/anxiety, 13% had CI, and 8% had co-existing depression/anxiety and CI. Those with depression/anxiety were more likely to have co-existing CI than those without depression/anxiety (29% vs. 6%; P<0.001). Patients that screened positive for preoperative CI experienced significantly worse psychological symptoms at all times compared to those without CI. Among those with preoperative CI, mean psychological symptoms remained above screening thresholds for depression/anxiety at all time points and significantly worsened at 90 days post-surgery compared to baseline levels. Patients with depression/anxiety reported significantly worse preoperative health, including greater pain and functional disability, as well as worse quality of life and sleep.

Given greater psychological burden in those with CI, screening for both conditions may enable early identification of patients at higher risk for poor outcomes. This approach may ultimately enhance risk stratification and optimization of perioperative care in older adults.