Association between Preoperative Depression and Length of Stay after Major Surgery: A Systematic Review and Meta-analysis.

Abstract

Preoperative depression is common among surgical patients and is associated with undesirable outcomes, such as pain and delirium in the immediate postoperative period. It is unclear whether depression also leads to longer postsurgical hospitalization. This review aimed to evaluate the association between preoperative depression and postoperative length of stay. A systematic review and a meta-analysis of studies were conducted that reported postsurgical length of stay in adult patients with preoperative depression who underwent inpatient surgery. The study was preregistered with PROSPERO (identification No. CRD42022296532). The Medline, Embase, Cochrane Controlled Register of Trials, and PsycINFO databases were searched from inception to June 30, 2023. The primary outcome was the mean difference in postoperative length of stay between patients with and without depression, which was pooled using multilevel random-effects meta-analysis. Secondary outcomes were unadjusted and adjusted odds ratios of extended length of stay in patients with depression, which were also pooled in meta-analyses. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate certainty, and Risk of Bias in Non-Randomised Studies - Exposure (ROBINS-E) was used to assess risk of bias. Of the 9,869 screened studies, 57 were included (n = 27,708,719 participants), of which 26 were prospective and 31 were retrospective. Patients with preoperative depression had a mean postoperative length of stay 0.98 days longer than those without (95% CI, 0.35 to 1.62). In secondary analyses, the unadjusted and adjusted odds ratios for an extended length of stay for patients with preoperative depression were 1.31 (95% CI, 0.94 to 1.82) and 1.27 (95% CI, 1.11 to 1.46), respectively. This meta-analysis demonstrated that patients with a history of depression or active depressive symptoms before surgery had longer postoperative hospitalization, although evidence was limited by risk of bias and publication bias. While preoperative screening for depression could potentially identify at-risk patients for targeted interventions, further research is needed to evaluate the efficacy of depression interventions in improving outcomes such as length of stay.