Anxiety is commonly encountered in patients undergoing medical procedures or surgeries and contributes to adverse outcomes including physiological damage, prolonged postoperative care, and rehabilitation. This study aimed to identify factors related to anxiety among patients undergoing coronary procedures.

This cross-sectional study was conducted at a tertiary hospital in Vietnam. Patients were included in our study if they were scheduled for coronary angiography or angioplasty. Pre-operative Intrusive Thought Inventory was employed to assess the patient's anxiety level.

Three hundred six patients scheduled for coronary procedure met inclusion criteria. High perioperative anxiety was reported by 56.2% of patients undergoing coronary angiography/angioplasty. Multivariable analysis showed that factors independently associated with high perioperative anxiety were no previous coronary angiography/angioplasty (odd ratio [OR]: 2.69 [1.44-5.01]), lack of pre-procedural anesthesia information (OR: 5.12 [2.54-10.31]) and prolonged indication-to-procedure duration (OR: 1.08 [1.05-1.11]).

Although coronary angiography or angioplasty were minimally invasive procedures, high perioperative anxiety was significant among patients scheduled for these procedures. Extended waiting time, no procedural experience, and inadequate anesthesia information were associated with increased levels of anxiety.

Background and Objective: Ambulatory holmium laser enucleation of prostate (HoLEP) has shown low rates of readmission and postoperative complications. However, the patient's experience has been undervalued. We aimed to measure the patient's perceived fear and anxiety during ambulatory HoLEP. Methods: We performed a prospective study on patients scheduled for HoLEP at our institution. We excluded patients with cognitive or psychiatric disorders and those who had to be hospitalized. The week preceding the surgery, we administered the Surgical Fear Questionnaire (SFQ) and the Hospital Anxiety and Depression Scale (HADS) by phone. The day following the surgery, we readministered the HADS and asked the patients if they would undergo HoLEP in the same setting. Key Findings and Limitations: Overall, 70 patients completed the study (mean age 72.3, standard deviation [SD] 6.5 years). The mean SFQ score was 18.4/90 (SD 13.5); the two highest rated items were "I am afraid of pain after the operation" and "I am afraid of unpleasant side effects after the operation." with a mean of 3.7/10 and 2.7/10, respectively. For the HADS, the mean preoperative score was 4.6/21 (SD 3.4), and the mean postoperative score was 3.9/21 (SD 3.0), with a mean difference of -0.7 (p = 0.059). The majority (90%) of patients reported they would undergo HoLEP in the same setting. Conclusions and Clinical Implications: Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again. Given the high satisfaction and low levels of anxiety, widespread adoption of ambulatory HoLEP should be considered. Patient Summary: Men with benign prostatic hyperplasia, or an enlarged prostate, often need surgery to improve urinary function. We studied the acceptability of same-day discharge surgery for this condition by assessing patients' anxiety, fear, and willingness to repeat the procedure. Most patients described low levels of anxiety and fear, and would undergo ambulatory HoLEP again.

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.

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.

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]).

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.

clinicaltrials.gov, no. NCT00512109 (main VISION study).

To determine whether intraoperative low-dose esketamine ameliorates depression in women having breast cancer surgery.

A prospective single-center double blind randomized placebo-controlled trial.

Perioperative period, operating room, post anesthesia care unit and hospital ward.

108 women 18-65 years old who were scheduled for elective breast cancer surgery. All had preoperative depressive symptoms as defined by Montgomery-Åsberg depression scores ≥12 (range, 0-60; higher scores indicate more severe depression).

Eligible participants were randomized to esketamine 0.25 mg/kg or saline placebo. Blinded trial drugs were given intravenously over the initial 40 min of anesthesia.

Our primary outcome was the fraction of patients who had at least a 50 % reduction in the Montgomery-Åsberg depression score within 3 postoperative days. Secondary outcomes included the fraction of patients with depression remission defined as Montgomery-Åsberg scores ≤10, the numeric value of the Montgomery-Åsberg depression scores, postoperative severe pain, and anxiety as determined by the Generalized Anxiety Disorder 7-item score. Adverse events were monitored for 72 postoperative hours.

54 women each were randomized to esketamine and saline, and 104 were available for our intent-to-treat analysis. The mean age was 50 years. Esketamine non-significantly doubled the fraction of patients who had a 50 % reduction in their depressions scores: 27 % vs 13 %, odds ratio 2.4, [95 % CI 0.9 to 6.6], P = 0.087. Montgomery-Åsberg depression scores were nearly a factor-of-two and significantly lower (better) on postoperative days 1 to 5 in patients given esketamine. Montgomery-Åsberg scores decreased significantly more from baseline in patients randomized to esketamine: mean difference - 2.5 [95 % CI -4.5 to -0.6], P = 0.010. Esketamine treatment had no significant effect on other secondary outcomes or on adverse events.

Intraoperative administration of 0.25 mg/kg esketamine did not significantly improve the fraction of depressed women having breast cancer patients who had a 50 % reduction in their depression scores at 3 days postoperatively. However, the observed factor-of-two treatment effect was clinically meaningful and esketamine significantly reduced short-term postoperative depression scores without provoking complications. Robust trials are warranted. Registration Trial registry:http://www.chictr.org.cn/; Identifier: ChiCTR2300071062.

Coronary artery disease and aortic valve stenosis are highly prevalent cardiovascular diseases worldwide, resulting in substantial morbidity and mortality. Surgical interventions, such as coronary artery bypass grafting and surgical aortic valve replacement, offer significant therapeutic benefits, including enhanced postoperative quality of life (QoL) and functional capacity, which are key indicators of surgical success. This editorial reviews recent studies on postoperative QoL and functional outcomes in patients undergoing cardiac surgery. Factors such as preoperative health, age, intensive care unit stay duration, surgical risk, and perioperative complications could influence these outcomes. Cardiac rehabilitation is pivotal in enhancing patient function, reducing frailty and improving long-term QoL.

Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, elaborated a new therapeutic offer, based on current ERAS evidence and using telerehabilitation, to enhance preoperative communication and education and improve pre- and postoperative health and psychological state. Results: An institutional web-based platform for remote rehabilitation will host digital content that covers three main areas, including information and communication, prehabilitation and rehabilitation with the offer of respiratory and muscular exercises and aerobic activities, and psychological and patient experience evaluations. These interventions will be achieved through purposely developed video tutorials that present the hospital environments, the relevant healthcare personnel, and their role during the in-hospital patient's journey, and illustrate tailored prehabilitation activities. A series of questionnaires will be administered to evaluate and follow the patient's psychological state and collect patient-reported experience measures. The platform was activated in September 2024 and this service will initially involve 100 patients undergoing minimally invasive mitral valve surgery. A first review of compliance and engagement will be carried out after four months and a complete review of the results after the first year. Conclusions: ERAS is associated with improved surgical outcomes. A person-centred treatment should also address the health and psychological difficulties that patients face before hospitalisation and after discharge. Telemedicine is a valid tool to expand treatment and monitoring outside the hospital. This experience may give new insights into the feasibility and effectiveness of providing home-based remote interventions aimed at a global improvement in results throughout the overall cardiac surgery journey.

Prehabilitation aims to reduce the impact of major surgery by improving the physical and psychological resilience of patients. Although exercise represents one component of prehabilitation, nutritional and psychological support are also critical to its effectiveness, and any benefits are only likely to be realised if the different components are implemented together, ideally in a behaviour change framework. Implementation of prehabilitation in cardiac surgery has not been as widespread as in other types of surgery, despite many randomised controlled trials (RCTs) of single interventions in this setting. The late adoption of a prehabilitation programme in cardiac surgery represents an opportunity to ensure that it is both clinically effective and cost-effective before widespread roll-out. This was mostly not done for prehabilitation in noncardiac surgery, where programmes were implemented largely without trials of these combined interventions. The most likely chance of an effective prehabilitation programme for cardiac surgery is to combine all the efficacious and implementable single interventions together in one comprehensive evidence-based programme. This should then be tested in an adequately powered multicentre RCT in a representative cardiac surgery population.

This study aimed to compare the outcomes of three-dimensional (3D) image-guided video-assisted thoracic surgery (VATS) segmentectomy performed with and without preoperative localization for the resection of small pulmonary nodules.

Between July 2015 and December 2022, 439 patients who underwent 3D image-guided VATS segmentectomy for early-stage lung cancer were enrolled. Based on whether preoperative localization was performed, the patients were divided into two groups as follows: the localization (n = 96) and nonlocalization groups (n = 343). The primary endpoints were the resection success rate and surgical margins.

Resection was successfully performed in 95 (99.0%) and 340 (99.1%) patients in the localization and nonlocalization groups, respectively (P = 1.000). One and three patients in the localization and nonlocalization groups, respectively, required conversion to extended segmentectomy due to inadequate surgical margins. The median surgical margins were 20 (range, 14-30) mm and 22 (range, 14-30) mm in the localization and nonlocalization groups, respectively (P = 0.410). However, overall complications were significantly more frequent in the localization group (9.4%) than in the nonlocalization group (4.1%; P = 0.040). This result was further supported by findings from multivariate logistic regression analysis. A subgroup analysis of high-risk small pulmonary nodules indicated no statistically significant differences between the groups concerning the primary endpoints.

3D image-guided VATS segmentectomy performed with and without preoperative localization had comparable resection success rates and surgical margins. However, the procedure without preoperative localization was associated with fewer postoperative complications.

Following cardiac surgery, active participation in cardiac rehabilitation (CR) is associated with reduced cardiovascular events and improved survival. However, CR attendance remains persistently low, with only ∼25% of patients participating. The Peer Coaching for Cardiac Patients (PCCP) pilot programme aimed to assess whether peer coaching could enhance CR participation and reduce perioperative anxiety and depression in cardiac surgery patients. Ten patients scheduled for elective cardiac surgery were enrolled, receiving 4 60-min coaching sessions via Zoom, by a coach who had undergone coronary artery bypass grafting in the past. Outcomes were measured by CR participation rates, Patient Health Questionnaire (PHQ)-9 scores, and a post-programme survey. Seven of the 10 patients completed the PCCP programme, all of which attended CR for an average of 19.3 ± 8.70 sessions and 9.57 ± 3.0 weeks. No statistically significant difference in PHQ-9 scores was observed (P = 0.341). Participants rated the programme highly in its role in anxiety reduction (9.0 ± 1.2) and likelihood of participating in CR (9.43 ± 1.05). These results suggests that peer coaching shows potential to support CR participation and address perioperative anxiety and depression. Future studies with larger sample sizes, well-defined control groups and extended follow-up are warranted to validate these preliminary findings.

The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients.

A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information.

The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations.

Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis.

Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences.

Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited.

We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission.

From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]).

Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.

Background/Objectives: Preoperative anxiety in cardiac surgery patients can adversely affect mental well-being and postoperative outcomes. Virtual reality (VR) patient education has been proposed as a novel method to enhance patient education and potentially reduce preoperative anxiety. The VR Patient Journey Trial aimed to evaluate the impact of VR patient education on preoperative anxiety and patient satisfaction compared to traditional education methods. Methods: This randomized controlled trial included 121 patients undergoing cardiac surgery. Participants were randomized to receive either VR patient education (intervention group) or traditional education (control group). Preoperative anxiety was measured using the State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information scale (APAIS). Patient satisfaction was assessed postoperatively through a custom questionnaire. Statistical analyses included linear regression and non-parametric testing. Results: Neither STAI nor APAIS scores showed differences in preoperative anxiety between both groups. However, the intervention group reported significantly higher patient satisfaction with the information provided (median score 9 vs. 8; p < 0.001). Furthermore, women reported higher levels of anxiety than men (p = 0.01), and open-ended feedback from participants indicated a need for more detailed information on postoperative rehabilitation and potential risks. Conclusions: The VR Patient Journey Trial revealed that, although VR patient education did not significantly reduce preoperative anxiety levels, it significantly improved patient satisfaction with the information provided. These results suggest that VR patient education can be a valuable addition to preoperative patient programs.

Different forms of immersive technology, such as Virtual Reality (VR) and Augmented Reality (AR), are getting increasingly invested in medicine. Advances in head-mounted display technology, processing, and rendering power have demonstrated the increasing utility of immersive technology in medicine and the healthcare environment. There are a growing number of publications on using immersive technology in cardiology. We reviewed the articles published within the last decade that reported case studies or research that uses or investigates the application of immersive technology in the broad field of cardiology - from education to preoperative planning and intraoperative guidance. We summarized the advantages and disadvantages of using AR and VR for various application categories. Our review highlights the need for a robust assessment of the effectiveness of the methods and discusses the technical limitations that hinder the complete integration of AR and VR in cardiology, including cost-effectiveness and regulatory compliance. Despite the limitations and gaps that have inhibited us from benefiting from immersive technologies' full potential in cardiology settings to date, its promising, impactful future for standard cardiovascular care is undoubted.

Preoperative anxiety is a common preoperative psychological state in patients with cancer and associated with worsening perioperative outcomes. However, high-quality prospective studies on preoperative anxiety in patients undergoing lung surgery are scarce.

We conducted a prospective cohort study, enrolling a total of 540 patients. Preoperative anxiety in patients undergoing thoracic surgery was measured using the Hospitalization Anxiety Scale. Patients were grouped according to the Hospitalization Anxiety Scale scores as follows: no anxiety (score <8) and anxiety (score ≥8). The association of preoperative anxiety with postoperative complications and non-complicated adverse events was determined by univariate regression and polynomial regression analyses.

A total of 121 patients (22.4 %) experienced preoperative anxiety. The anxiety group had a longer average hospital stay (4.33 vs. 3.85 days). Postoperative complications were similar between groups, but the anxiety group reported worse sleep quality (measured by the Athens Insomnia Scale). Regarding postoperative pain, both groups had comparable rates of mild and severe pain on postoperative day 1. However, the anxiety group experienced significantly higher rates of severe pain on postoperative day 2 and mild pain on postoperative day 3. Additionally, the incidence of postoperative nausea and vomiting was significantly higher in the anxiety group on postoperative day 1.

Preoperative anxiety may not increase the rates of postoperative complications in patients undergoing lung surgery. However, it may be associated with postoperative sleep disturbances, pain, nausea, and vomiting, as well as prolong the length of postoperative hospitalization.

Depression and anxiety are common comorbidities in patients undergoing coronary artery bypass grafting (CABG), with potential adverse effects on surgical outcomes. Effective interventions to reduce depression and anxiety in these patients are therefore warranted. This study investigated the effectiveness of peer-based video education compared to conventional video education in reducing perioperative depression and anxiety in CABG patients.

A three-arm, parallel, randomized, controlled trial design was employed.

A total of 114 participants were randomly assigned to 1 of 3 groups (n = 38 per group): standard education (control), conventional video education, and peer-based video education. State anxiety levels were measured using the Spielberger State Anxiety Questionnaire at 1 day before surgery (baseline), 1 hour before surgery, and 4 weeks after surgery. Depression levels were measured using the Beck Depression Inventory Short-Form at baseline and 4 weeks after surgery. Statistical analyses, including χ2, Fisher's exact test, one-way analysis of variance, and repeated-measures analysis of variance, were applied to analyze the collected data.

Both peer-based and conventional video education groups demonstrated lower preoperative anxiety levels compared to the control group. However, only the peer-based video education group exhibited a statistically significant difference (P < .05). Four weeks after surgery, anxiety and depression levels decreased in all participants compared to baseline, with no statistically significant differences among the three groups.

Our findings suggest that peer-based video education is more effective in controlling preoperative anxiety in patients undergoing CABG than conventional video education and standard education. Moreover, video-based education, whether conventional or peer-based, appears to be as effective as standard education in reducing anxiety and depression 4 weeks after CABG surgery. Further research is warranted to investigate the influence of content and presentation methods on patient outcomes and explore the potential long-term benefits of video-based education in promoting patient care.

Depression is a common cause of long-lasting disability and preoperative mental health state that has important implications for optimizing recovery in the perioperative period. In older elective surgical patients, the prevalence of preoperative depression and associated adverse pre- and postoperative outcomes are unknown. This systematic review and meta-analysis aimed to determine the prevalence of preoperative depression and the associated adverse outcomes in the older surgical population.

Systematic review and meta-analysis.

MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) for relevant articles from 2000 to present.

Patients aged ≥65 years old undergoing non-cardiac elective surgery with preoperative depression assessed by tools validated in older adults. These validated tools include the Geriatric Depression Scale (GDS), Hospital Depression and Anxiety Scale (HADS), Beck Depression Inventory-II (BDI), Patient Health Questionnaire-9 (PHQ-9), and the Centre for Epidemiological Studies Depression Scale (CESD).

Preoperative assessment.

The primary outcome was the prevalence of preoperative depression. Additional outcomes included preoperative cognitive impairment, and postoperative outcomes such as delirium, functional decline, discharge disposition, readmission, length of stay, and postoperative complications.

Thirteen studies (n = 2824) were included. Preoperative depression was most assessed using the Geriatric Depression Scale-15 (GDS-15) (n = 12). The overall prevalence of preoperative depression was 23% (95% CI: 15%, 30%). Within non-cancer non-cardiac mixed surgery, the pooled prevalence was 19% (95% CI: 11%, 27%). The prevalence in orthopedic surgery was 17% (95% CI: 9%, 24%). In spine surgery, the prevalence was higher at 46% (95% CI: 28%, 64%). Meta-analysis showed that preoperative depression was associated with a two-fold increased risk of postoperative delirium than those without depression (32% vs 23%, OR: 2.25; 95% CI: 1.67, 3.03; I2: 0%; P ≤0.00001).

The overall prevalence of older surgical patients who suffered from depression was 23%. Preoperative depression was associated with a two-fold higher risk of postoperative delirium. Further work is needed to determine the need for depression screening and treatment preoperatively.

Patients undergoing surgery commonly experience anxiety during their procedure which can negatively affect surgical outcomes. Music therapy has emerged as a promising noninvasive approach to reducing anxiety particularly in patients undergoing otolaryngology procedures.The objective of this study is to evaluate the effectiveness of music therapy on anxiety and pain during these procedures.

PubMed and Embase.

A systematic search was conducted using the PRISMA approach to retrieve articles published between 1980 and March 2024. The search terms were applied to PubMed and Embase databases. The search term yielded a total of 669 articles on PubMed and 1027 articles on Embase, 5 of which met the inclusion criteria.

Five studies consisting of 4 randomized controlled trials and one case-control studies were included in our study, resulting in a total of 381 patients undergoing various otolaryngology procedures. Music therapy was found to reduce preoperative, perioperative, and postoperative anxiety and pain levels compared to control groups. Furthermore, patients who received music therapy experienced improvements in physiological parameters such as heart rate and blood pressure, indicating a positive impact on stress.

Music therapy offers a potentially cost-effective and noninvasive method of reducing anxiety and pain in otolaryngological surgery patients. Our study indicates that music therapy can serve as a valuable addition to traditional pharmacological approaches in managing surgery-related anxiety and pain. However, more research is needed to standardize music therapy protocols and compare its effect in comparison to other nonpharmacologic and pharmacologic modalities to optimize care for patients.

A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery.

This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire.

According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach.

Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.

Preoperative depression is an underappreciated comorbidity that has important implications for postoperative outcomes. Screening for symptoms of depression before surgery can identify patients with or without a previous diagnosis of depression who could benefit from perioperative interventions to improve mood. Preoperative screening programmes are feasible to implement, although care must be taken to ensure that patients who are most likely to benefit are included.

Older surgical patients with depression often experience poor postoperative outcomes. Poor outcomes may stem from brain-hazardous medications and subadequate antidepressant dosing.

This was a retrospective, observational cohort study covering the period between January 1, 2021 and December 31, 2021. Patients ≥60 years of age who underwent inpatient surgery and had an overnight stay at an integrated academic health care system comprising 14 hospitals were eligible. We analyzed the prevalence of home central nervous system (CNS)-active potentially inappropriate medication (PIM) and potential subadequate antidepressant dosing in older surgical patients receiving home antidepressants. Univariable and multivariable regression models were used to identify factors associated with home CNS-active PIM prescribing and potential subadequate antidepressant dosing. Additionally, outcomes were compared among patients receiving and not receiving CNS-active PIMs and patients receiving and not receiving subadequate antidepressant dosing.

A total of 8031 patients were included in this study (47% female, mean age = 70 years) of whom 2087 (26%) were prescribed antidepressants. Roughly one-half (49%, 95% confidence interval [CI], 46.5-50.1) of patients receiving home antidepressants were also receiving ≥1 CNS-active PIM and 29% (95% CI, 27.0-29.3) were receiving a potential subadequate dose. Factors associated with an increased likelihood of receiving a home CNS-active PIM included female sex (adjusted odds ratio [aOR], 1.46), anxiety (aOR, 2.43), asthma or chronic obstructive pulmonary disease (aOR, 1.39), and serotonin-norepinephrine reuptake inhibitor use (aOR, 1.54). Patients aged ≥75 years (aOR, 1.57), black race (aOR, 1.48) and those with congestive heart failure (aOR, 1.33) were more likely to be prescribed a potential subadequate antidepressant dose. Patients receiving potential subadequate antidepressant doses were discharged home less often (64% vs 73%), had a longer hospital length of stay (9 days vs 7 days), and a higher mortality rate (18% vs 10%) compared to patients receiving adequate home antidepressant doses (P-value for all <0.01). No differences in these outcomes were found among patients receiving home antidepressants with or without CNS-active PIMs.

Older surgical patients receiving antidepressants are frequently prescribed brain-hazardous medications and potentially subadequate antidepressant doses. Those receiving subadequate antidepressant doses may be at risk for worse postoperative outcomes compared to patients receiving adequate doses. The role of preoperative medication optimization to improve outcomes for older surgical patients should be evaluated.

Depression is a prevalent mood disorder during the perioperative period, with both preoperative concurrent depression and new-onset postoperative depression impacting postoperative recovery. Recent studies have indicated that the dissociative anesthetic esketamine may alleviate perioperative depressive symptoms.

This meta-analysis aimed to assess the efficacy and safety of esketamine in treating perioperative depression.

We selected randomized controlled trials comparing esketamine to placebo in terms of postoperative depressive symptoms. The primary outcome was postoperative depression scores, with secondary outcomes including the prevalence of postoperative depression, pain scores using the Visual Analogue Scale or Numeric Rating Scale, and incidences of adverse reactions such as nausea/vomiting, dizziness, dreams/nightmares, hallucinations.

We enrolled a total of 17 studies involving 2462 patients. The esketamine group demonstrated a significant reduction in postoperative depression scores within one week after surgery (SMD -0.47, 95% CI (-0.66, -0.27), P < 0.001) and over the long term (SMD -0.44, 95% CI (-0.79, -0.09), P = 0.01). Furthermore, esketamine significantly decreased the prevalence of postoperative depression both within one week (RR 0.46, 95% CI (0.33, 0.63), P < 0.001) and over the long term (RR 0.50, 95% CI (0.36, 0.70), P < 0.001). Additionally, esketamine effectively relieved pain on the first postoperative day compared to control. However, it also increased the risks of dizziness and hallucinations for a short time.

This meta-analysis suggests that the intraoperative or postoperative application of esketamine could be a potentially effective treatment for perioperative depression, although the increased risk of adverse reactions should be considered.

Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncological and orthopaedic, investigating whether a perioperative mental health intervention, with psychological and pharmacological components, reduces perioperative symptoms of depression and anxiety in older surgical patients.

Adults ≥60 years undergoing cardiac, orthopaedic or oncological surgery will be enrolled in one of three-linked type 1 hybrid effectiveness/implementation RCTs that will be conducted in tandem with similar methods. In each trial, 100 participants will be randomised to a remotely delivered perioperative behavioural treatment incorporating principles of behavioural activation, compassion and care coordination, and medication optimisation, or enhanced usual care with mental health-related resources for this population. The primary outcome is change in depression and anxiety symptoms assessed with the Patient Health Questionnaire-Anxiety Depression Scale from baseline to 3 months post surgery. Other outcomes include quality of life, delirium, length of stay, falls, rehospitalisation, pain and implementation outcomes, including study and intervention reach, acceptability, feasibility and appropriateness, and patient experience with the intervention.

The trials have received ethics approval from the Washington University School of Medicine Institutional Review Board. Informed consent is required for participation in the trials. The results will be submitted for publication in peer-reviewed journals, presented at clinical research conferences and disseminated via the Center for Perioperative Mental Health website.

NCT05575128, NCT05685511, NCT05697835, pre-results.

The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery.

The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates.

Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion.

Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

Surgical patients with previous depression frequently experience postoperative depressive symptoms. This study's objective was to determine the feasibility of a placebo-controlled trial testing the impact of a sustained ketamine infusion on postoperative depressive symptoms.

This single-centre, triple-blind, placebo-controlled randomised clinical trial included adult patients with depression scheduled for inpatient surgery. After surgery, patients were randomly allocated to receive ketamine (0.5 mg kg-1 over 10 min followed by 0.3 mg kg-1 h-1 for 3 h) or an equal volume of normal saline. Depressive symptoms were measured using the Montgomery-Asberg Depression Rating Scale. On post-infusion day 1, participants guessed which intervention they received. Feasibility endpoints included the fraction of patients approached who were randomised, the fraction of randomised patients who completed the study infusion, and the fraction of scheduled depression assessments that were completed.

In total, 32 patients were allocated a treatment, including 31/101 patients approached after a protocol change (31%, 1.5 patients per week). The study infusion was completed without interruption in 30/32 patients (94%). In each group, 7/16 participants correctly guessed which intervention they received. Depression assessments were completed at 170/192 scheduled time points (89%). Between baseline and post-infusion day 4 (pre-specified time point of interest), median depressive symptoms decreased in both groups, with difference-in-differences of -1.00 point (95% confidence interval -3.23 to 1.73) with ketamine compared with placebo. However, the between-group difference did not persist at other time points.

Patient recruitment, medication administration, and clinical outcome measurement appear to be highly feasible, with blinding maintained. A fully powered trial may be warranted.

NCT05233566.

The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use.

This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery.

We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%-90.3%) and specificity of 93.5% (91.5-95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity.

These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.

Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.

Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients' unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery.

We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded.

Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: (1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). (2) Cohort-specific adaptations were recommended based on differing patient needs. (3) Compassion was identified by patients as the most important element.

We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations.

NCT05110690 (11/08/2021).

Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area.

To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022.

An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05.

The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety.

Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.

Preoperative anxiety is a challenging problem in the preoperative care of patients. Identifying risk factors helps nurses provide psychological support during the pre-operative visit so that stress can be reduced.

This study aimed to determine the prevalence of surgical anxiety and related factors in hospitalized surgical patients.

This research was designed as a point-prevalence study. The study was completed with 223 patients hospitalized in the surgical clinics of a tertiary hospital in Turkey. Surgical anxiety questionnaire (SAQ) and State-trait anxiety inventory (STAI) were used for the assessment of anxiety.

Preoperative anxiety prevalence was 69.5% according to the SAQ and 49.3% according to STAI. Women, participants with no primary school education, those who were unemployed and had low income, those with no previous surgery, those living in fear of surgery, the participants who underwent major surgery and general anesthesia, and those who did not have knowledge about the surgical procedure and anesthesia had higher anxiety according to the two scales. A highly significant and positive correlation was found between total STAI and total SAQ.

The importance of surgical anxiety for the health system, which affects two out of every three hospitalized patients, should not be underestimated. Therefore, national and global plans should be made to prevent and manage surgical anxiety.

Video propaganda is reported effectively improving patients' understanding of operation. However, whether a video introducing patients' most concerns can reduce preoperative anxiety and promote recovery stays unsealed. In this study, we investigated the effects of complementary therapy of educational video during preoperative visit. The results showed that thirty-five (23.2%) parents in Group Control were diagnosed as anxiety according to SAS, and nineteen (12.3%) patients were diagnosed after video intervention. The APAIs anxiety score and APAIs information score in Group Video were lower than those in Group Control. Compared with Group Control, video visit helped to increase the first-attempt pass rate of the knowledge retention exam and solve the patient's most worried concerns, and decrease incidence of emergence agitation, total cost of hospitalization and length of hospital stay. Moreover, video visit improved satisfaction degrees of patients and their main family members. Briefly, our study demonstrated video visit can improve patients' knowledge of anesthesia and decrease their preoperative anxiety, which may represent an important complementary therapy to routine preoperative visits.

Background and Objectives: It remains unclear which domains of preoperative health-related quality of life (HRQOL) and mental health are predictive of postoperative clinical and patient-reported outcomes in colorectal cancer (CRC) patients. Materials and Methods: A prospective cohort of 78 CRC patients undergoing elective curative surgery was recruited. The EORTC QLQ-C30 and HADS questionnaires were administered preoperatively and one month after surgery. Results: Preoperative cognitive functioning scores (95% CI 0.131-1.158, p = 0.015) and low anterior resection (95% CI 14.861-63.260, p = 0.002) independently predicted poorer 1-month postoperative global QOL. When postoperative complications were represented using the comprehensive complication index (CCI), poorer preoperative physical function scores were associated with higher CCI scores (B = -0.277, p = 0.014). Preoperative social function score (OR = 0.925, 95% CI 0.87 to 0.99; p = 0.019) was an independent predictor for 30-day readmission, while physical functioning score (OR = -0.620, 95% CI -1.073--0.167, p = 0.008) was inversely related to the length of hospitalization. The overall regressions for 1-month postoperative global QOL (R2: 0.546, F: 1.961, p = 0.023) and 30-day readmission (R2: 0.322, χ2: 13.129, p < 0.001) were statistically significant. Conclusions: Various QLQ-C30 domains were found to be predictive of postoperative outcomes, including complications, readmission, and length of hospitalization. Preoperative cognitive dysfunction and low AR were independent predictors of poorer postoperative global QOL. Future research should seek to examine the efficacy of targeting specific baseline QOL domains in improving clinical as well as patient-reported outcomes after CRC surgery.

Ketamine, a commonly used general anesthetic, can produce rapid and sustained antidepressant effect. However, the efficacy and safety of the perioperative application of ketamine on postoperative depression remains uncertain. We performed a meta-analysis to determine the effect of perioperative intravenous administration of ketamine on postoperative depression. Randomized controlled trials comparing ketamine with placebo in patients were included. Primary outcome was postoperative depression scores. Secondary outcomes included postoperative visual analog scale (VAS) scores for pain and adverse effects associated with ketamine. Fifteen studies with 1697 patients receiving ketamine and 1462 controls were enrolled. Compared with the controls, the ketamine group showed a reduction in postoperative depression scores, by a standardized mean difference (SMD) of -0.97, 95% confidence interval [CI, -1.27, -0.66], P < 0.001, I2 = 72% on postoperative day (POD) 1; SMD-0.65, 95% CI [-1.12, -0.17], P < 0.001, I2 = 94% on POD 3; SMD-0.30, 95% CI [-0.45, -0.14], P < 0.001, I2 = 0% on POD 7; and SMD-0.25, 95% CI [-0.38, -0.11], P < 0.001, I2 = 59% over the long term. Ketamine reduced VAS pain scores on POD 1 (SMD-0.93, 95% CI [-1.58, -0.29], P = 0.005, I2 = 97%), but no significant difference was found between the two groups on PODs 3 and 7 or over the long term. However, ketamine administration distinctly increased the risk of adverse effects, including nausea and vomiting (risk ratio [RR] 1.40, 95% CI [1.12, 1.75], P = 0.003, I2 = 30%), headache (RR 2.47, 95% CI [1.41, 4.32], P = 0.002, I2 = 19%), hallucination (RR 15.35, 95% CI [6.24, 37.34], P < 0.001, I2 = 89%), and dizziness (RR 3.48, 95% CI [2.68, 4.50], P < 0.001, I2 = 89%) compared with the controls. In conclusion, perioperative application of ketamine reduces postoperative depression and pain scores with increased risk of adverse effects.

To optimize recovery and improve prognosis, people who have had an acute cardiac event (ACE) need support to manage their cardiac risk. In 2008, we conducted a randomized controlled trial (RCT) of Beating Heart Problems (BHP) , an 8-wk group program based on cognitive behavioral therapy (CBT) and motivational interviewing (MI), designed to improve behavioral and mental health. This study investigated 14-yr mortality status for RCT participants in order to evaluate the survival impact of the BHP program.

In 2021, mortality data on 275 participants from the earlier RCT were obtained from the Australian National Death Index. Survival analysis was undertaken to investigate differences in survival for participants in the treatment and control groups.

Over the 14-yr follow-up period, there were 52 deaths (18.9%). For those aged <60 yr, there was a significant survival benefit to program participation, with 3% deaths in the treatment group and 13% deaths in the control group ( P = .022). For those aged ≥60 yr, the death rate was identical in both groups (30%). Other significant predictors of mortality included older age, higher 2-yr risk score, lower functional capacity, lower self-rated health, and having no private health insurance.

Participation in the BHP conferred a survival benefit for patients aged <60 yr but not for participants overall. The findings highlight the long-term benefit of behavioral and psychosocial management of cardiac risk through CBT and MI for those who are younger at the time of their first ACE.

Depression is a common problem in patients with cardiovascular diseases. Identifying a risk factor model of depression has been postulated. A model of the risk of depression would provide a better understanding of this disorder in this population. We sought to construct a model of the risk factors of depression in patients following cardiac surgery, with the use of machine learning.

Two hundred and seventeen patients (65.4% men; mean age 65.14 years) were asked to complete the short form health survey-12 (SF-12v.2), three months after hospital discharge. Those at risk of depression were identified based on the SF-12 mental component summary (MCS). Centroid class principal component analysis (CCPCA) and the classification and regression tree (CART) were used to design a model.

A risk of depression was identified in 29.03% of patients. The following variables explained 82.53% of the variance in depression risk: vitality, limitation of activities due to emotional problems (role-emotional, RE), New York Heart Association (NYHA) class, and heart failure. Additionally, CART revealed that decreased vitality increased the risk of depression to 45.44% and an RE score > 68.75 increased it to 63.11%. In the group with an RE score < 68.75, the NYHA class increased the risk to 41.85%, and heart failure further increased it to 44.75%.

Assessing fatigue and vitality can help health professionals with identifying patients at risk of depression. In addition, assessing functional status and dimensions of fatigue, as well as the impact of emotional state on daily functioning, can help determine effective intervention options.

Depression is a chronic illness that affects mood, physical health, and overall vitality and quality of life. Depression has been associated with an increased risk of all-cause and cardiovascular mortality among patients with peripheral arterial disease (PAD). Therefore, this study aimed to compare the incidence of depression before and after endovascular treatment in patients with lower limb PAD. This is an important clinical issue considering the worldwide increase in PAD with the aging population and the known negative impact of depression on recovery. This was a retrospective sub-analysis of data from the Tokyo Peripheral Vascular Intervention Study using the TOMA-CODE registry. The presence and extent of depressive symptoms were evaluated using the patient health questionnaire (PHQ-9), with a depressive tendency score of ≥ 5. The PHQ-9 score was evaluated before endovascular treatment (EVT) and at 4 (± 1) weeks after EVT. The study population consisted of 87 patients who completed the PHQ-9 before EVT, with 76 completing the post-EVT PHQ-9. Of these 76, 19 had a pre-EVT score ≥ 5. Overall, there was no difference in the pre- and post-EVT scores (P = 0.091). There was no significant change in the 19 patients with a pre-EVT score ≥ 5 (mean 9.2 ± 4.4); however, there was a tendency to improve in the pre- to post-EVT score (mean, 6.9 ± 5.2; P = 0.059). Diabetes was a significant negative factor for pre- to post-EVT score improvement (P = 0.023). Overall, symptoms of depression showed the tendency to improve at 30 days post-EVT. However, diabetes was associated with lower improvement in symptoms.

Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients' unique needs. We developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery.

We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded.

Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: 1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). 2) Cohort-specific adaptations were recommended based on differing patient needs. 3) Compassion was identified by patients as the most important element.

We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations.

In patients undergoing cardiac surgery, preoperative depressive and anxiety symptoms and increased postoperative C-reactive protein (CRP) levels have been associated with adverse outcomes. We tested the hypothesis that preoperative depressive and anxiety symptoms predict elevated in-hospital CRP levels after cardiac surgery.

The study participants were 96 consecutive patients (mean age [SD], 67.6 [10.3] years, 78.1% men) from a single cardiac surgery centre who underwent either isolated coronary artery bypass grafting (CABG) (n = 34), isolated valve surgery (n = 29), combined procedures (including different combinations of CABG, valve surgery, aortic surgery, and others) (n = 30), or other cardiac surgical procedures (n = 3). Participants self-rated depressive and anxiety symptoms using the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) questionnaire before undergoing elective surgery. CRP levels were measured every 24 h up to 10 days post-surgery. Linear mixed (random effects) regression analysis examined the association between preoperative depressive and anxiety symptoms and CRP levels over time, adjusting for pre-surgery CRP levels, demographics, cardiovascular risk factors, medications, and surgery-related variables.

Before surgery, 32.2% of patients had clinically relevant depressive symptoms (PHQ-9 score ≥5) and 32.2% of patients had clinically relevant anxiety symptoms (GAD-7 score ≥5). More severe depressive symptoms (estimate [95% CI]: 0.081 [0.023, 0.139], p = 0.007) and more severe anxiety symptoms (0.059 [0.005, 0.113], p = 0.032) predicted CRP levels over 10 days, independent of covariates. Furthermore, CRP levels were higher in patients with than in those without clinically relevant depressive symptoms (0.697 [0.204, 1.191], p = 0.006) and were predicted by both more severe somatic (0.132 [0.035, 0.229], p = 0.008) and cognitive (0.128 [0.014, 0.242], p = 0.029) depressive symptoms.

Preoperative depressive and anxiety symptoms were independent predictors of elevated CRP levels up to 10 days post-surgery. Such a mechanism may help explain the increased morbidity and mortality risk in patients with depression and anxiety who undergo cardiac surgery.

Comorbid psychiatric illness has been associated with worse outcomes after some major surgical procedures. We hypothesized that patients with preexisting mood disorders would have worse postoperative and oncologic outcomes after pancreatic cancer resection.

This retrospective cohort study analyzed Surveillance, Epidemiology, and End Results patients with resectable pancreatic adenocarcinoma. A preexisting mood disorder was classified if a patient was diagnosed and/or treated with medication approved for depression/anxiety within 6 months before surgery.

Of 1305 patients, 16% had a preexisting mood disorder. Mood disorders had no impact on hospital length of stay (12.9 vs 13.2 days, P = 0.75), 30-day complications (26% vs 22%, P = 0.31), 30-day readmissions (26% vs 21%, P = 0.1), or mortality (30 days: 3% vs 4%, P = 0.35); only an increased 90-day readmissions rate (42% vs 31%, P = 0.001) was observed. No effect on adjuvant chemotherapy receipt (62.5% vs 69.2%, P = 0.06) or survival (24 months, 43% vs 39%, P = 0.44) was observed.

Preexisting mood disorders influenced 90-day readmissions after pancreatic resection, but not other postoperative or oncologic outcomes. These findings suggest that affected patients should be expected to have outcomes similar to patients without mood disorders.