- Design
- Single-blind hybrid effectiveness-implementation randomised trial
- Population
- 306 adults aged 60 or older with depressive or anxiety symptoms before cardiac, cancer or orthopaedic surgery
- Primary outcome
- PHQ-ADS change at 3 months after surgery
- Effect
- Mean difference 2.20 points (95% CI 0.16-4.24); cancer surgery 4.93 (1.51-8.36)
A single-blind randomised trial at a US hospital network enrolled 326 adults aged 60 or older with clinically meaningful depression or anxiety scheduled for cardiac, cancer or orthopaedic surgery. The intervention combined psychological management with medication optimisation; the control received self-management materials.
In 306 analysed, the combined PHQ-ADS score fell by 2.20 points more with the intervention at three months (95% CI 0.16-4.24). The effect was largest after cancer surgery (4.93 points, 1.51-8.36), uncertain after cardiac surgery, and absent after orthopaedic surgery.
Depression and anxiety before surgery predict worse recovery in older adults, but few services act on them. This shows a structured perioperative programme is deliverable and helps, though modestly overall.
For liaison psychiatry, the cancer surgery pathway looks the best place to start.
- Screen older adults for depression and anxiety at preoperative assessment.
- Review psychotropics before surgery rather than stopping them by default.
- Prioritise liaison input for patients having cancer surgery.
- Watch for delirium risk when changing medications around surgery.
Why it matters
Perioperative mood care can be delivered at scale, and its benefit appears concentrated in cancer surgery rather than spread evenly.
Don't overread it
The subgroup differences by surgery type were not the primary analysis and could be chance.
The statistics, in plain English
An overall difference of 2.2 points on a 48-point scale is small, and the lower confidence limit of 0.16 is close to no effect. Subgroups each had about 100 people, so their estimates are imprecise.
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