术前心理困扰与非心脏手术1年内的死亡率相关

IF 3.7 2区医学 Q1 PSYCHIATRY

General hospital psychiatry Pub Date : 2025-04-11 DOI:10.1016/j.genhosppsych.2025.04.002

Renée El-Gabalawy , Jordana L Sommer , Jitender Sareen , Corey S Mackenzie , P.J. Devereaux , Kailey Penner , Sadeesh Srinathan

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引用次数: 0

摘要

目的探讨非心脏手术患者术前心理困扰与术后30天并发症及1年死亡率之间的关系。方法数据取自VISION队列研究的子样本(n = 997；2011 - 2012)。参与者被安排在全身或局部麻醉下接受重大非心脏手术。参与者在手术当天使用Kessler-6 （K6）量表自我报告过去30天的心理困扰。通过访谈和/或图表评估并发症。多变量logistic回归分析了术前心理困扰与术后并发症的关系。模型拟合了社会人口统计学、手术类型、术前医疗发病率和吸烟情况。在完成K6的参与者中（n = 938）， 7.9%的人在1年内死亡。在控制年龄、种族、性别、手术类型、术前医疗发病率和吸烟后，较高水平的术前心理困扰与30天并发症相关，如心肌梗死、非致死性心脏骤停、腿/手臂深静脉血栓形成/肺栓塞、新发急性肾功能衰竭、肺炎和充血性心力衰竭(AOR3（第3模型），1.12,[95% CI, 1.02-1.22, p <；0.05])和1年死亡率(AOR3, 1.09, [95% CI, 1.02-1.18, p <；0.05])。敏感性分析表明，后一种关联是由抑郁症状驱动的（AOR3, 1.17） [95% CI 1.04-1.33, p <；0.05])，但没有焦虑(AOR2, 0.94 [95% CI, 0.61-1.62, p >；0.05])。结论术前焦虑升高可增加术后30天并发症及1年死亡率。这些结果强调了未来研究的必要性，以检验在围手术期支持患者的心理健康是否可以降低风险。临床试验注册：clinicaltrials.gov，编号；NCT00512109（主视觉研究）。

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Preoperative psychological distress is associated with mortality within 1 year of non-cardiac surgery

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.

Clinical Trial Registration: clinicaltrials.gov, no. NCT00512109 (main VISION study).

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来源期刊

General hospital psychiatry 医学-精神病学

CiteScore

9.60

自引率

2.90%

发文量

125

审稿时长

20 days

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.