Renée El-Gabalawy , Jordana L Sommer , Jitender Sareen , Corey S Mackenzie , P.J. Devereaux , Kailey Penner , Sadeesh Srinathan
{"title":"Preoperative psychological distress is associated with mortality within 1 year of non-cardiac surgery","authors":"Renée El-Gabalawy , Jordana L Sommer , Jitender Sareen , Corey S Mackenzie , P.J. Devereaux , Kailey Penner , Sadeesh Srinathan","doi":"10.1016/j.genhosppsych.2025.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the association between preoperative psychological distress and postoperative complications at 30 days and mortality at 1 year in a non-cardiac surgery sample.</div></div><div><h3>Method</h3><div>Data were taken from a subsample of the VISION cohort study (<em>n</em> = 997; 2011–2012). Participants were scheduled to undergo major non-cardiac surgery under general or regional anesthesia. Participants self-reported past 30-day psychological distress on the day of surgery using the Kessler-6 (K6) Scale. Complications were assessed via interviews and/or chart reviews. Multivariable logistic regressions characterized the relationship between preoperative psychological distress and postoperative complications. Models were fitted for sociodemographics, surgery type, preoperative medical morbidity, and smoking.</div></div><div><h3>Results</h3><div>Among participants with a completed K6 (<em>n</em> = 938), 7.9 % experienced mortality within 1 year. After controlling for age, ethnicity, sex, surgery type, preoperative medical morbidity, and smoking, higher levels of preoperative psychological distress were associated with 30 day complications such as myocardial infarction, non-fatal cardiac arrest, leg/arm deep vein thrombosis/ pulmonary embolism, new acute renal failure, pneumonia, and congestive heart failure (AOR3 (3rd model), 1.12, [95 % CI, 1.02–1.22, <em>p</em> < 0.05]) and 1-year mortality (AOR3, 1.09, [95 % CI, 1.02–1.18, p < 0.05]). Sensitivity analyses demonstrate that the latter association was being driven by symptoms of depression (AOR3, 1.17 [95 % CI 1.04–1.33, p < 0.05]) but not anxiety (AOR2, 0.94 [95 % CI, 0.61–1.62, <em>p</em> > 0.05]).</div></div><div><h3>Conclusion</h3><div>Elevated preoperative distress increased the risk of 30-day complications and mortality at 1 year. These results underscore the need for future research to examine if supporting patients' mental health during the perioperative period can mitigate risk.</div><div><strong>Clinical Trial Registration</strong>: <span><span>clinicaltrials.gov</span><svg><path></path></svg></span>, no. <span><span>NCT00512109</span><svg><path></path></svg></span> (main VISION study).</div></div>","PeriodicalId":12517,"journal":{"name":"General hospital psychiatry","volume":"95 ","pages":"Pages 25-31"},"PeriodicalIF":3.7000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"General hospital psychiatry","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0163834325000908","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective
To characterize the association between preoperative psychological distress and postoperative complications at 30 days and mortality at 1 year in a non-cardiac surgery sample.
Method
Data were taken from a subsample of the VISION cohort study (n = 997; 2011–2012). Participants were scheduled to undergo major non-cardiac surgery under general or regional anesthesia. Participants self-reported past 30-day psychological distress on the day of surgery using the Kessler-6 (K6) Scale. Complications were assessed via interviews and/or chart reviews. Multivariable logistic regressions characterized the relationship between preoperative psychological distress and postoperative complications. Models were fitted for sociodemographics, surgery type, preoperative medical morbidity, and smoking.
Results
Among participants with a completed K6 (n = 938), 7.9 % experienced mortality within 1 year. After controlling for age, ethnicity, sex, surgery type, preoperative medical morbidity, and smoking, higher levels of preoperative psychological distress were associated with 30 day complications such as myocardial infarction, non-fatal cardiac arrest, leg/arm deep vein thrombosis/ pulmonary embolism, new acute renal failure, pneumonia, and congestive heart failure (AOR3 (3rd model), 1.12, [95 % CI, 1.02–1.22, p < 0.05]) and 1-year mortality (AOR3, 1.09, [95 % CI, 1.02–1.18, p < 0.05]). Sensitivity analyses demonstrate that the latter association was being driven by symptoms of depression (AOR3, 1.17 [95 % CI 1.04–1.33, p < 0.05]) but not anxiety (AOR2, 0.94 [95 % CI, 0.61–1.62, p > 0.05]).
Conclusion
Elevated preoperative distress increased the risk of 30-day complications and mortality at 1 year. These results underscore the need for future research to examine if supporting patients' mental health during the perioperative period can mitigate risk.
期刊介绍:
General Hospital Psychiatry explores the many linkages among psychiatry, medicine, and primary care. In emphasizing a biopsychosocial approach to illness and health, the journal provides a forum for professionals with clinical, academic, and research interests in psychiatry''s role in the mainstream of medicine.