title: Influence of Depression on Recovery After Major Noncardiac Surgery: A Prospective Cohort Study.
abstract: OBJECTIVE
  To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it.
  
  
  BACKGROUND
  Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model of postoperative outcome considers this dimension.
  
  
  METHODS
  This prospective multicenter study included patients undergoing liver resections, a model of major abdominal surgery, between September 2013 and September 2014 in 8 centers. The primary outcome was postoperative morbidity or mortality (assessed by the Clavien-Dindo grade and the Comprehensive Complication Index) and the postoperative length of stay (LOS). Depression and anxiety were assessed preoperatively with the Hospital Anxiety and Depression Scale and a validated cutoff. Surgeons were preoperatively asked to predict outcome. Multivariable mixed-effects Cox models were fitted to evaluate the influence of depression on actual and surgeon-anticipated outcome and on the difference between actual and surgeon-anticipated LOS.
  
  
  RESULTS
  Hospital Anxiety and Depression Scale identified 142 of 591 patients (24.0%) as depressed and 40.3% as anxious. Neither condition was independently correlated with morbidity or mortality, but depression was an independent risk factor for prolonged LOS (adjusted hazard ratio 0.65, 95% confidence interval 0.50-0.83, P = 0.001). Depression was not correlated with anticipated LOS. Three variables explained the gap between anticipated and actual LOS: depression (P = 0.003), associated surgical procedures in addition to liver resection (P = 0.007), and postoperative morbidity (P < 0.001).
  
  
  CONCLUSIONS
  Nearly 1 quarter of patients undergoing major abdominal surgery are depressed preoperatively. This depression is a strong independent predictor of prolonged LOS and partly explains surgeons' failure to predict outcome accurately.
authors.affiliation: *INSERM-U1178, Paris, France †Université Paris Sud, Université Paris Descartes, Paris, France ‡Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Clichy, France §Université de la Picardie Jules Vernes, Département de Psychologie, CRP-CPO, Amiens, France ¶Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France ||Department of Digestive Surgery, Amiens University Hospital, Amiens, France **Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France ††Department of Visceral Surgery and Transplantation, Hautepierre Hospital, University Hospitals of Strasbourg, Strasbourg, France ‡‡Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Pitié-Salpêtrière, Paris, France §§Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Croix Rousse, Lyon, France ¶¶Department of Hepatobiliopancreatic Surgery, Hôpital Edouard Herriot, Lyon, France ||||Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France ***Center de Soins Psychothérapeutiques de Transition pour Adolescents, Hôpital d'Argenteuil, Argenteuil, France. †††Université Paris Diderot, Paris, France.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Orri
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Boleslawski
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Caroline
authors.initials: C
authors.lastname: Barry
authors.forename: Christine
authors.initials: C
authors.lastname: Hassler
authors.forename: Emilie
authors.initials: E
authors.lastname: Gregoire
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Mabrut
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Anne
authors.initials: A
authors.lastname: Revah-Levy
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
mesh_terms: D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013514:Surgical Procedures, Operative