Depression and postoperative complications: an overview

Abstract

BackgroundThe interaction of depression and anesthesia and surgery may result in significant increases in morbidity and mortality of patients. Major depressive disorder is a frequent complication of surgery, which may lead to further morbidity and mortality.Literature searchSeveral electronic data bases, including PubMed, were searched pairing “depression” with surgery, postoperative complications, postoperative cognitive impairment, cognition disorder, intensive care unit, mild cognitive impairment and Alzheimer’s disease.Review of the literatureThe suppression of the immune system in depressive disorders may expose the patients to increased rates of postoperative infections and increased mortality from cancer. Depression is commonly associated with cognitive impairment, which may be exacerbated postoperatively. There is evidence that acute postoperative pain causes depression and depression lowers the threshold for pain. Depression is also a strong predictor and correlate of chronic post-surgical pain. Many studies have identified depression as an independent risk factor for development of postoperative delirium, which may be a cause for a long and incomplete recovery after surgery. Depression is also frequent in intensive care unit patients and is associated with a lower health-related quality of life and increased mortality. Depression and anxiety have been widely reported soon after coronary artery bypass surgery and remain evident one year after surgery. They may increase the likelihood for new coronary artery events, further hospitalizations and increased mortality. Morbidly obese patients who undergo bariatric surgery have an increased risk of depression. Postoperative depression may also be associated with less weight loss at one year and longer. The extent of preoperative depression in patients scheduled for lumbar discectomy is a predictor of functional outcome and patient’s dissatisfaction, especially after revision surgery. General postoperative mortality is increased.ConclusionsDepression is a frequent cause of morbidity in surgery patients suffering from a wide range of conditions. Depression may be identified through the use of Patient Health Questionnaire-9 or similar instruments. Counseling interventions may be useful in ameliorating depression, but should be subject to clinical trials.

Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease

“…Although the current study did not examine cases of repeat surgery, previous studies have shown an association between depression and increased incidence of repeat spinal surgery 22,29,36,37. These findings, combined with the findings of the current study, highlight that for both clinical and economic reasons, and to improve preoperative informed consent procedures, patients, and health care systems, would benefit from implementing preoperative psychosocial assessment of patients with degenerative vertebral disc disease 38,39…”

Depression in Cancer Care

“…23,24 Depression often increases sensitivity to and monitoring of physical sensations and thereby may increase pain. 25 Depression is a large contributor to the wish for hastened death (e.g., suicide, physician-assisted suicide, euthanasia, and rejection of proper treatment). 26 There is some evidence that depression decreases immune function, although its relationship with cancer prognosis remains unclear.…”

Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions

“…Just as the pre-existence of sleep disorders,5 mental health disorders,6 metabolic syndrome,7 substance use8–10 and systemic arthropathies11 can place patients at significant risk for physical complications and can impede recovery,12 developing one or more conditions as a consequence of surgery could also limit recovery.…”