Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study

The Use of Prophylactic Ketamine to Mitigate Postoperative Depressive Symptoms: A Systematic Review

PURPOSE

Depression is predicted to be the leading burden of disease worldwide by 2030 with a prevalence of 10% to 60% in the surgical population. Depressive symptoms in the perioperative population are associated with a myriad of grave complications, including higher morbidity and mortality. This systematic review aims to determine whether a single dose of intravenous ketamine can be used prophylactically as a routine resilience-enhancing agent in all high-risk adult patients undergoing surgery to mitigate depressive symptoms postoperatively by appraising evidence of existing literature.

DESIGN

An evidence-based systematic review.

METHODS

The databases PubMed, CINAHL, and Scopus were searched, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search and Medical Subject Headings (MeSH) terms used: "ketamine," "surgical procedures," "surgical," "surgery," "depression," and "depressive disorder."

FINDINGS

In 9 randomized controlled trials (RCTs), bolus ketamine doses of 0.1 mg/kg to 1 mg/kg were administered intraoperatively or in the postanesthesia care unit. The primary outcome was the subjective feelings of depression as evaluated by different validated depression screening tools and seven RCTs observed statistically significant findings between the control and intervention (ketamine) groups with postoperative depression scores. Two RCTs did not find a significant change in depression scores.

CONCLUSIONS

Research on the use of prophylactic ketamine as an antidepressant in the perioperative population offers insight into changing routine practices and can shape how mental health is viewed in hospitals. Further research is warranted on the safety profile of ketamine, and risk stratification with careful consideration of baseline depressive symptoms, timing, and its use across a wider variety of surgical subspecialties.

Comparative Efficacy of Video Games Versus Midazolam in Reducing Perioperative Anxiety in Pediatric Patients: Systematic Review and Meta-Analysis

Background

Pediatric patients undergoing surgery frequently experience significant anxiety, which can result in adverse effects such as prolonged sedation and behavioral changes associated with pharmacological interventions such as oral midazolam. Video games offer a nonpharmacological distraction method that shows promise in alleviating procedural anxiety without significant adverse effects. However, the effectiveness of video games compared to midazolam in managing perioperative anxiety remains uncertain.

Objective

This study aimed to evaluate the effectiveness of video game interventions in reducing perioperative anxiety in pediatric patients undergoing general anesthesia.

Methods

We conducted a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library, supplemented by reference screening. Primary outcomes included anxiety levels assessed during parent separation and mask induction procedures, while secondary outcomes encompassed emergence delirium, postoperative behavior, and length of stay in the postanesthesia care unit (PACU). The risk of bias was assessed using the Risk of Bias 2 scale. Data were synthesized descriptively and through meta-analysis, with the certainty of the evidence evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

Results

Six randomized controlled trials involving 612 participants were included in the analysis. Children who participated in video game interventions reported significantly lower anxiety levels during parent separation (standardized mean difference, SMD -0.31, 95% CI -0.50 to -0.12; P=.001), with high certainty, and during mask induction (SMD -0.29, 95% CI -0.52 to -0.05; P=.02), with moderate certainty, compared to those receiving oral midazolam. Additionally, significant differences in postoperative behavior changes in children were observed compared to oral midazolam (SMD -0.35, 95% CI -0.62 to -0.09; P=.008). Children in the video game intervention groups also had a shorter length of stay in the PACU (mean difference, MD -19.43 min, 95% CI -31.71 to -7.16; P=.002). However, no significant differences were found in emergence delirium (MD -2.01, 95% CI -4.62 to 0.59; P=.13).

Conclusions

Video game interventions were more effective than midazolam in reducing perioperative anxiety among pediatric patients, improving postoperative behavior, and shortening the length of stay in the PACU. However, video games alone did not outperform midazolam in managing emergence delirium. Further high-quality research is needed for more conclusive results.

Food Insecurity and Clinical Outcomes in Surgical Trauma Patients

Importance

Food insecurity, which is the lack of consistent access to sufficient and nutritious food, impacts over 1.3 billion individuals worldwide. The impact of food insecurity on primary care and medical subspecialties is recognized, but its influence on surgical outcomes remains underexplored.

Objective

To investigate the association between food insecurity and postoperative clinical outcomes in adult surgical trauma patients.

Design, Setting, and Participants

This prospective longitudinal cohort study was conducted from October 2021 to June 2023 and surveyed patients at admission and at 1 and 3 months postoperatively. This multicenter study was conducted across 3 public and private tertiary care centers in India. Adult patients who underwent inpatient operative intervention for traumatic injury were included through consecutive sampling.

Exposures

Food insecurity, which was identified using the validated Hunger Vital Sign tool. This was determined at admission as preoperative food insecurity. Also assessed was a subset of participants who were food secure at admission but then became food insecure during the follow-up period.

Main Outcomes and Measures

Postoperative complications and length of stay. These outcomes were tracked during hospitalization and also at 1 month and 3 months after discharge to compare between time points.

Results

A total of 848 patients (median [IQR] age, 32 [24-45] years; 692 male [82%]) were included in this analysis. Of the total cohort, 174 participants (21%) reported experiencing food insecurity in the year before admission. Patients with food insecurity had significantly higher rates of postoperative complications compared with those without food insecurity (41.4% [72 of 174] vs 12.5% [84 of 671]; odds ratio [OR], 3.68; 95% CI, 2.24-6.05). Additionally, patients with food insecurity had a longer median (IQR) length of stay (13 [6-28] days vs 5 [3-9] days; incidence rate ratio, 1.51; 95% CI, 1.31-1.74). Furthermore, new-onset food insecurity at 1 month postoperatively was associated with an increased risk of new complications at 3 months postoperatively (OR, 5.06; 95% CI, 2.21-11.13).

Conclusions and Relevance

Results demonstrate that food insecurity was significantly associated with increased postoperative complications and longer hospital stays in surgical trauma patients. Routine screening for food insecurity and targeted interventions like medically tailored meals, food prescription programs, and philanthropic food resources may mitigate the detrimental impact of food insecurity on surgical outcomes.

Just another tool in their repertoire: uncovering insights into public and patient perspectives on clinicians' use of machine learning in perioperative care

OBJECTIVES

Successful implementation of machine learning-augmented clinical decision support systems (ML-CDSS) in perioperative care requires the prioritization of patient-centric approaches to ensure alignment with societal expectations. We assessed general public and surgical patient attitudes and perspectives on ML-CDSS use in perioperative care.

MATERIALS AND METHODS

A sequential explanatory study was conducted. Stage 1 collected public opinions through a survey. Stage 2 ascertained surgical patients' experiences and attitudes via focus groups and interviews.

RESULTS

For Stage 1, a total of 281 respondents' (140 males [49.8%]) data were considered. Among participants without ML awareness, males were almost three times more likely than females to report more acceptance (OR = 2.97; 95% CI, 1.36-6.49) and embrace (OR = 2.74; 95% CI, 1.23-6.09) of ML-CDSS use by perioperative teams. Males were almost twice as likely as females to report more acceptance across all perioperative phases with ORs ranging from 1.71 to 2.07. In Stage 2, insights from 10 surgical patients revealed unanimous agreement that ML-CDSS should primarily serve a supportive function. The pre- and post-operative phases were identified explicitly as forums where ML-CDSS can enhance care delivery. Patients requested for education on ML-CDSS's role in their care to be disseminated by surgeons across multiple platforms.

DISCUSSION AND CONCLUSION

The general public and surgical patients are receptive to ML-CDSS use throughout their perioperative care provided its role is auxiliary to perioperative teams. However, the integration of ML-CDSS into perioperative workflows presents unique challenges for healthcare settings. Insights from this study can inform strategies to support large-scale implementation and adoption of ML-CDSS by patients in all perioperative phases. Key strategies to promote the feasibility and acceptability of ML-CDSS include clinician-led discussions about ML-CDSS's role in perioperative care, established metrics to evaluate the clinical utility of ML-CDSS, and patient education.

Preoperative predictors of acute postoperative anxiety and depression using ecological momentary assessments: a secondary analysis of a single-centre prospective observational study

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.

Psychological Consequences Associated With Coronary Artery Bypass Graft Surgery: A Bibliometric Analysis

The current paper explores the mutual impact of psychological factors and cardiac surgery on each other using bibliometric analysis with the help of indicative cited publications, co-cited journals, and collaborations between countries, institutions, and authors. Citation analysis is an attractive methodology because it provides quantitative information that is readily acquired with electronic databases and that can be compared across topic areas. The bibliometric investigation was done using the PubMed database, Scopus, Web of Science, etc. with the help of appropriate MeSH words. Followed by an analysis of data with the help of CiteSpace 5.3.R4, Microsoft Excel 2016, and IBM SPSS Statistics 20.0 software (IBM Corp., Armonk, NY). The software extracts the number of scientific publications, citation frequency, and keyword trends. Relational figures and tables were obtained for data interpretation. The records of 259 articles were analyzed using bibliometric investigation which shows the increasing incidence of psychological consequences linked with coronary artery bypass grafting (CABG) surgery. This indicates that immediate management is required to overcome this. The present bibliometric study emphasizes the need for psychological screening and management of post-CABG patients. This will lay the path for organizing and prioritizing future research on vascular psychiatry and its early management.

Clinical outcome and risk factors for subcutaneous emphysema in patients with lung cancer after video-assisted thorascopic surgery

Background and purpose

With the clinical application of minimally invasive surgery and concept of enhanced recovery after surgery, the incidence of postoperative complications in lung cancer patients has been significantly reduced. However, postoperative subcutaneous emphysema (SE) becomes the main factor affecting the early discharge of patients. The aim of this study was to analyze the clinical outcome and risk factors for postoperative SE in lung cancer patients.

Methods

The clinical data of 414 lung cancer patients who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from September 2021 to December 2021 were prospectively collected. The incidence, severity and treatment of patients who had SE, surgery approach, application of drainage tube and clinical information were analyzed.

Results

The incidence rate of postoperative SE in patients with lung cancer was 33.09% (137/414) and mild cases accounted for the vast majority (30.19%, 125/414). Multivariate analysis indicated that male [odds ratio (OR) = 2.247, P = .014] and advanced age (OR = 1.021, P = .043) were main risk factors for postoperative SE in patients with lung cancer. Conservative treatment was the main treatment option for SE (98.5%, 135/137). The average hospital stay in the subcutaneous emphysema group (5.49 ± 4.41 days) was significantly longer than that in the non-subcutaneous emphysema group (4.44 ± 3.32 days) (P = .014) and no significant statistical difference in the average total hospital cost between the two groups (7,798.31 ± 1,414.85$ vs. 7,501.14 ± 1,605.18$, P = .072).

Conclusion

Postoperative SE in patients with minimally invasive lung cancer is mainly mild, and conservative treatment is appropriate for most cases.

Patients' expectations and experiences of provided surgery-related patient education: A descriptive longitudinal study

AIMS

The aim of this study was to explore the educational expectations and experiences of surgical patients.

DESIGN

Prospective, longitudinal, descriptive and two-centre study. Data were collected with questionnaires at the hospital and 6 weeks and 6 months postsurgery.

METHODS

Patients undergoing elective surgery and hospitalized overnight from January to July 2016 answered questions about the content of received pre-operative and pre-discharge education, topics they wanted more information on, sources of information, satisfaction with and usefulness of the information and if their recovery was as expected.

RESULTS

Patients (N = 697, 49% male, mean age 64.1 [SD 12.6] years) perceived the provided education as useful and satisfactory but less so after discharge. Most common topics which they expected more education about were postoperative complications, pain management, fatigue, lack of stamina and expected recovery time. Most patients received information through face-to-face teaching (79.7%) and in writing (78.4%). Expectations on recovery were related to patients' satisfaction with the education and how useful they evaluated it.