The Impact of Preoperative Chronic Pain on Postoperative Depressive States in Elderly Patients Undergoing Joint Replacement Surgery: A Secondary Analysis Based on Prospective Data
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 575
- 试验地点
- 1
- 主要终点
- Incidence and Severity Classification of Postoperative Depressive States (within 7 days)
研究概览
简要总结
Background:
Postoperative depression is a significant complication that hinders recovery in elderly patients undergoing joint replacement surgery. Although preoperative chronic pain is common in this population and pain and depression frequently coexist, the predictive role and underlying mechanisms of preoperative chronic pain on postoperative depression remain unclear. This study aims to systematically explore the association between the two, providing a basis for optimizing perioperative management and improving patient outcomes.
Methods:
This study is a secondary analysis of multicenter prospective data, including elderly patients who underwent elective knee or hip replacement surgery between April 2020 and April 2022 from a perioperative database of elderly patients in China. The impact of preoperative chronic pain on the occurrence of depressive states within 7 days after surgery was systematically evaluated using univariate and multivariate logistic regression analysis, propensity score matching, and subgroup analysis.
详细描述
Introduction Against the backdrop of the deepening global trend of population aging, the number of elderly individuals undergoing joint replacement surgery has increased significantly. Although this surgery effectively alleviates pain and restores joint function, perioperative mood disorders have become a key factor affecting patient recovery and long-term quality of life [1]. Among common orthopedic surgeries in the elderly, hip and knee replacements hold a prominent position. Since joint function directly impacts patients' basic living abilities such as walking and mobility, the risk of postoperative anxiety and depression is particularly pronounced. Studies indicate that the incidence of depression after joint replacement surgery can reach 33%, while the incidence of anxiety ranges between 25% and 33% [2,3]. Preoperative chronic pain is a prevalent clinical symptom in this patient population; however, whether an association exists between it and postoperative depression remains unclear due to a lack of systematic clinical evidence.
Notably, elderly patients undergoing joint replacement often have a long history of chronic pain, with studies showing a preoperative pain prevalence as high as 43.2% [4]. Known common risk factors for depression in the elderly include gender, age, sleep status, pain, and activities of daily living [5-7]. In the perioperative context, studies have confirmed that postoperative pain exacerbates mood disorders and increases the prevalence of depression [4]. However, compared to postoperative pain, preoperative chronic pain may exert multifaceted effects on postoperative outcomes, including mood and functional recovery [4,8]. Pre-existing chronic pain, as a potential and important predictor, has not been sufficiently explored for its unique impact on postoperative depression.
Based on this background, this study included 575 elderly patients undergoing joint replacement surgery to investigate the effect of preoperative chronic pain on postoperative depression in this population.
II. Research Objectives and Significance
Objectives:
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 65 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age ≥ 65 years.
- •No cognitive impairment or history of mental illness.
- •Underwent elective joint replacement surgery.
- •Completed postoperative assessments, including questionnaires for depression, anxiety, and delirium.
排除标准
- •Non-general anesthesia.
- •Patients admitted to the intensive care unit postoperatively.
- •Medical centers with fewer than 50 cases. -
结局指标
主要结局
Incidence and Severity Classification of Postoperative Depressive States (within 7 days)
时间窗: within 7 days after surgery
Postoperative depressive states were assessed using the Chinese version of the Patient Health Questionnaire-9 (PHQ-9). This scale was administered at bedside within 7 days after surgery by trained researchers. It is a self-reported tool comprising 9 items and is widely used for the efficient screening of clinical depressive symptoms. The assessment results were interpreted as follows: a total score ≥ 5 indicated the presence of a postoperative depressive state, with scores of 5-9 classified as mild, 10-14 as moderate, and 15-27 as moderately severe to severe.
次要结局
未报告次要终点
研究者
Weidong Mi
Director of the Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital
Chinese PLA General Hospital