BACKGROUND Postoperative anxiety and depression can negatively affect surgical outcomes and patient wellbeing. This study aimed to quantify the incidence of postoperative worsening anxiety and depression symptoms and to identify preoperative predictors of these conditions. METHODS This prospective, observational cohort study included 1168 patients undergoing surgery lasting >1 h with overnight admission at a university-affiliated quaternary referral centre. Postoperative anxiety and depression symptoms were measured using standardised, thrice-daily ecological momentary assessments (EMAs) for 30 days. Co-primary outcomes were worsening anxiety and depression symptoms, each defined as a slope >0 when EMA was modelled as a linear function of time. Multivariable logistic regression was performed to identify independent preoperative predictors of each outcome. RESULTS Postoperative worsening anxiety occurred in 60 patients (5%), and postoperative worsening depression occurred in 86 patients (7%). Predictors of postoperative worsening of anxiety symptoms included preoperative Patient-Reported Outcome Measurement Information System (PROMIS) anxiety symptoms (adjusted odds ratio [aOR] 2.48, 95% credible interval [CI] 1.29-4.79, for mild symptoms; aOR 2.22, 95% CI 1.10-4.51, for moderate to severe symptoms), and preoperative pain (aOR 3.46, 95% CI 1.32-9.12). Predictors of postoperative worsening depression symptoms included preoperative PROMIS depression symptoms (aOR 2.26, 95% CI 1.24-4.14, for mild symptoms; aOR 3.79, 95% CI 2.10-6.81, for moderate to severe symptoms). Self-reported history of anxiety or depression did not independently predict either outcome. CONCLUSIONS Postoperative worsening anxiety and depression appear to be associated more closely with preoperative active mental health or pain symptoms rather than self-reported history of these conditions. Preoperative identification of at-risk patients will require screening for symptoms rather than simple history taking.

中文翻译：

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使用生态瞬时评估的术后急性焦虑和抑郁的术前预测因子：单中心前瞻性观察研究的二次分析。


背景 术后焦虑和抑郁会对手术结果和患者健康产生负面影响。本研究旨在量化术后焦虑和抑郁症状恶化的发生率，并确定这些情况的术前预测因子。方法 这项前瞻性观察性队列研究包括 1168 名接受手术持续 >1 h 的患者，并在大学附属的四级转诊中心过夜入院。使用标准化的、每天三次的生态瞬时评估 （EMA） 测量术后焦虑和抑郁症状，持续 30 天。共同主要结局是焦虑和抑郁症状恶化，当 EMA 被建模为时间的线性函数时，每个结局都定义为斜率 >0。进行多变量 logistic 回归以确定每个结局的独立术前预测因子。结果 60 例患者 （5%） 术后焦虑恶化，86 例 （7%） 患者术后抑郁恶化。术后焦虑症状恶化的预测因素包括术前患者报告结局测量信息系统 （PROMIS） 焦虑症状 （调整比值比 [aOR] 2.48,95% 可信区间 [CI] 1.29-4.79，轻度症状;aOR 2.22,95% CI 1.10-4.51，中度至重度症状）和术前疼痛 （aOR 3.46,95% CI 1.32-9.12）。术后抑郁症状恶化的预测因素包括术前 PROMIS 抑郁症状（轻度症状 aOR 2.26,95% CI 1.24-4.14;中度至重度症状 aOR 3.79,95% CI 2.10-6.81）。自我报告的焦虑或抑郁病史不能独立预测这两种结局。 结论 术后恶化的焦虑和抑郁似乎与术前活跃的心理健康或疼痛症状更密切相关，而不是自我报告的这些疾病史。术前识别高危患者需要筛查症状，而不是简单的病史采集。