The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study

Preoperative psychological distress and acute postoperative pain among abdominal surgery patients

OBJECTIVE

To analyze preoperative psychological distress symptoms and their association with acute postoperative pain in patients undergoing abdominal surgery.

METHOD

Prospective observational study conducted at a University Hospital in Minas Gerais, Brazil. The sample included 118 patients in the hospital's elective abdominal surgery program. Psychological distress symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Pain levels were measured using the numeric verbal scale (NVS, 0-10 points) from admission to discharge from the post-anesthesia care unit. Descriptive statistics and an ordinal regression model were utilized to detect related factors, with a threshold for significance established at p < 0.05. Pain levels at discharge from the post-anesthesia care unit was considered the outcome variable.

FINDINGS

Preoperatively, 50.8 % exhibited symptoms of anxiety (HADS-A ≥ 8) and 16.1 % exhibited symptoms of depression (HADS-D ≥ 8), with 14.4 % presenting both symptoms. The prevalence of pain (NVS >0) in the post-anesthesia care unit was 40.3 %. At admission, 5.8 % of patients reported moderate to severe pain (NVS ≥ 4), increasing to 29.7 % at 60 min and 22.1 % at discharge. Regression analysis showed that anxiety or depression (OR = 4.49, p < 0.01) significantly increased the likelihood of experiencing higher pain levels, which was even greater when both symptoms coexisted (OR = 10.19, p < 0.01). Additionally, older age (OR = 0.94, p < 0.01) and inadequate pain management (OR = 7.67, p < 0.01) were significant predictors of pain levels at discharge.

CONCLUSION

Preoperative psychological distress, particularly the simultaneous presence of anxiety and depressive symptoms, significantly elevates the likelihood of heightened pain intensity in patients undergoing abdominal surgery.

Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis

Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.

Navigating Life Post-emergency Laparotomy: A Narrative Review on Quality-of-Life Outcomes

An emergency laparotomy is a life-saving surgical procedure performed to address acute abdominal conditions. While crucial for immediate survival, this procedure can have significant long-term implications for patients' quality of life. This comprehensive review examines the physical, psychological, and social outcomes following emergency laparotomy, highlighting the importance of addressing quality-of-life concerns in this patient population. Key findings reveal that patients may experience complications, psychological distress, and challenges in social functioning post-procedure. Age, gender, and access to support networks influence outcomes. Recommendations for clinical practice include routine assessment of quality of life, multidisciplinary care, and patient education. Further research is needed to understand predictors of poor outcomes and evaluate interventions to improve quality of life post-emergency laparotomy. Healthcare providers can enhance patient care and outcomes in this vulnerable population by addressing these issues.

Management of Enterocutaneous Fistula in Crohn's Disease by Embolization With Glue Injection and Coiling: A Case Report

There is one reported case of a pancreatoduodenal fistula that was managed using combined coil embolization and fibrin glue after the failure of other methods. Herein, we document this case to highlight the value of coil embolization and fibrin glue as surgical alternatives for fistula treatment. We present a case of a 39-year-old female patient who has a known case of Crohn's disease (CD) and presented with an enterocutaneous fistula (ECF) after her most recent surgery. With the failure of conservative approaches and as she refused any surgical interventions, fibrin glue injection and coiling were used. As a conclusion, embolization may work well as a surgical management alternative due to its simplicity.