Association of Dexmedetomidine With Postoperative Depressive Symptoms in Older Surgical Patients: A Prospective Multicenter Study

IF 4.8 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-05-19 DOI:10.1111/cns.70407

Xinyu Hao, Zhuoning Zhang, Lujia Yang, Yongxin Guo, Fuyang Cao, Jiangbei Cao, Yanhong Liu, Jingsheng Lou, Ziyao Xu, Yulong Cui, Yunxiao Bai, Xiaoping Gu, Difen Wang, Qianyu Cui, Zhikang Zhou, Hao Shen, Jingjia Sun, Weidong Mi, Li Tong

{"title":"Association of Dexmedetomidine With Postoperative Depressive Symptoms in Older Surgical Patients: A Prospective Multicenter Study","authors":"Xinyu Hao, Zhuoning Zhang, Lujia Yang, Yongxin Guo, Fuyang Cao, Jiangbei Cao, Yanhong Liu, Jingsheng Lou, Ziyao Xu, Yulong Cui, Yunxiao Bai, Xiaoping Gu, Difen Wang, Qianyu Cui, Zhikang Zhou, Hao Shen, Jingjia Sun, Weidong Mi, Li Tong","doi":"10.1111/cns.70407","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Neuropsychiatric symptoms significantly impact surgical recovery, quality of life, and long-term survival. To investigate the association between intraoperative dexmedetomidine administration and the incidence of postoperative depressive symptoms in noncardiac surgical patients.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A multicenter prospective observational study of older surgical patients over 65 years of age from April 2020 to April 2022. The primary outcome was the incidence of postoperative 7-day depressive symptoms. Secondary outcomes were the incidence of postoperative 7-day anxiety symptoms, sleep disturbance, and delirium. A logistic regression model based on the random effect was used to determine the association between dexmedetomidine administration and the outcomes. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were employed to address data imbalance. Subgroup analyses based on specific populations were performed to explore the relationship between dexmedetomidine and depressive symptoms.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 5591 patients, 20.5% (1148) received intraoperative dexmedetomidine. The incidence of postoperative 7-day depressive symptoms was significantly lower in the dexmedetomidine group compared to the nondexmedetomidine group (unadjusted: 7.6% vs. 26.7%, <i>p</i> < 0.001; PSM: 7.9% vs. 29.0%, IPTW: 8.7% vs. 25.8%, <i>p</i> < 0.001). Dexmedetomidine was significantly associated with the remission of postoperative 7-day depressive symptoms (adjusted random-effect model: risk ratio [RR] 0.104, 95% CI, 0.080–0.140, <i>p</i> < 0.001; PSM: RR 0.311, 95% CI, 0.242–0.415, <i>p</i> < 0.001; IPTW: RR 0.297, 95% CI, 0.253–0.343, <i>p</i> < 0.001). Additionally, dexmedetomidine demonstrated protective effects against postoperative anxiety symptoms, sleep disturbance, and delirium. In age, gender, cumulative comorbidity, frailty, ASA physical status, and inhaled anesthetic subgroups, we also found that dexmedetomidine was associated with a reduction in postoperative depressive symptoms in older noncardiac patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Intraoperative dexmedetomidine administration was associated with a reduction in postoperative 7-day depressive symptoms, anxiety symptoms, sleep disturbances, and delirium in older patients undergoing noncardiac surgery.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>The clinical trial protocol of this study was registered in the Clinical Trial registry (NCT06362408).</p>\n </section>\n \n <section>\n \n <h3> Prior Presentations</h3>\n \n <p>The authors have nothing to report.</p>\n </section>\n </div>","PeriodicalId":154,"journal":{"name":"CNS Neuroscience & Therapeutics","volume":"31 5","pages":""},"PeriodicalIF":4.8000,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cns.70407","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"CNS Neuroscience & Therapeutics","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/cns.70407","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Neuropsychiatric symptoms significantly impact surgical recovery, quality of life, and long-term survival. To investigate the association between intraoperative dexmedetomidine administration and the incidence of postoperative depressive symptoms in noncardiac surgical patients.

Methods

A multicenter prospective observational study of older surgical patients over 65 years of age from April 2020 to April 2022. The primary outcome was the incidence of postoperative 7-day depressive symptoms. Secondary outcomes were the incidence of postoperative 7-day anxiety symptoms, sleep disturbance, and delirium. A logistic regression model based on the random effect was used to determine the association between dexmedetomidine administration and the outcomes. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were employed to address data imbalance. Subgroup analyses based on specific populations were performed to explore the relationship between dexmedetomidine and depressive symptoms.

Results

Of 5591 patients, 20.5% (1148) received intraoperative dexmedetomidine. The incidence of postoperative 7-day depressive symptoms was significantly lower in the dexmedetomidine group compared to the nondexmedetomidine group (unadjusted: 7.6% vs. 26.7%, p < 0.001; PSM: 7.9% vs. 29.0%, IPTW: 8.7% vs. 25.8%, p < 0.001). Dexmedetomidine was significantly associated with the remission of postoperative 7-day depressive symptoms (adjusted random-effect model: risk ratio [RR] 0.104, 95% CI, 0.080–0.140, p < 0.001; PSM: RR 0.311, 95% CI, 0.242–0.415, p < 0.001; IPTW: RR 0.297, 95% CI, 0.253–0.343, p < 0.001). Additionally, dexmedetomidine demonstrated protective effects against postoperative anxiety symptoms, sleep disturbance, and delirium. In age, gender, cumulative comorbidity, frailty, ASA physical status, and inhaled anesthetic subgroups, we also found that dexmedetomidine was associated with a reduction in postoperative depressive symptoms in older noncardiac patients.

Conclusion

Intraoperative dexmedetomidine administration was associated with a reduction in postoperative 7-day depressive symptoms, anxiety symptoms, sleep disturbances, and delirium in older patients undergoing noncardiac surgery.

Trial Registration

The clinical trial protocol of this study was registered in the Clinical Trial registry (NCT06362408).

Prior Presentations

The authors have nothing to report.

查看原文本刊更多论文

右美托咪定与老年外科患者术后抑郁症状的关联：一项前瞻性多中心研究

背景：神经精神症状显著影响手术恢复、生活质量和长期生存。目的探讨非心脏手术患者术中右美托咪定给药与术后抑郁症状发生率的关系。方法对2020年4月~ 2022年4月65岁以上老年外科患者进行多中心前瞻性观察研究。主要观察指标为术后7天抑郁症状的发生率。次要结局是术后7天焦虑症状、睡眠障碍和谵妄的发生率。采用基于随机效应的logistic回归模型来确定右美托咪定给药与结局之间的关系。采用倾向得分匹配（PSM）和逆概率处理加权（IPTW）来解决数据不平衡问题。对特定人群进行亚组分析，探讨右美托咪定与抑郁症状之间的关系。结果5591例患者中，20.5%（1148例）患者术中使用右美托咪定。右美托咪定组术后7天抑郁症状的发生率显著低于非右美托咪定组(未经调整：7.6%对26.7%,p < 0.001；PSM: 7.9%比29.0%,IPTW: 8.7%比25.8%,p & lt; 0.001)。右美托咪定与术后7天抑郁症状缓解显著相关(校正随机效应模型：风险比[RR] 0.104, 95% CI, 0.080-0.140, p < 0.001；PSM: RR 0.311, 95% CI, 0.242 - -0.415, p & lt; 0.001;IPTW: RR 0.297, 95% CI, 0.253 - -0.343, p & lt; 0.001)。此外，右美托咪定对术后焦虑症状、睡眠障碍和谵妄具有保护作用。在年龄、性别、累积合并症、虚弱、ASA身体状况和吸入麻醉剂亚组中，我们还发现右美托咪定与老年非心脏病患者术后抑郁症状的减轻有关。结论术中给予右美托咪定与老年非心脏手术患者术后7天抑郁症状、焦虑症状、睡眠障碍和谵妄的减少有关。本研究的临床试验方案已在临床试验注册中心（NCT06362408）注册。作者没有什么可报告的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.