The Developmental Trajectories Of Perioperative Depressive Symptoms In Middle-Aged And Elderly Cardiac Surgery Patients And It’s Associations With Their Quality Of Life And Frailty

ObjectivesThis study assessed perioperative depressive symptoms in middle-aged and elderly cardiac surgery patients at four stages:day 2 after patient admission(T1),7 days after surgery(T2),1 day before discharge(T3),and 3 months after discharge(T4),and in the perioperative period identified heterogeneous developmental trajectories of patients’ depressive symptoms,and further explored the effect of heterogeneous developmental trajectory subgroups of depressive symptoms on the quality of life and frailty at 3 months after discharge.MethodsA total of 269 middle-aged and elderly patients who underwent cardiac surgery in a tertiary care medical institution in Shandong Province from December 2020 to November 2021 were selected for the study.The general information questionnaire and clinical information questionnaire were used to collect socio-demographic characteristics and diseaserelated information of patients at day 2 after patient admission and 1 day before discharge;and 9-item Patients Health Questionnaire Depression Module(PHQ-9)was used to assess depressive symptoms in four stages of the perioperative period from T1 to T4.The 12-item short from Health survey(SF-12),Fried Frailty Phenotype,was used to assess patients’quality of life and frailty at T4.Statistical analysis was performed using SPSS 25.0 and Mplus 7.0.Statistical analysis methods included Latent Class Growth Analysis(LCGA),descriptive analysis,T-test,chi-square test or Fisher’s exact test,repeated measures ANOVA,one-way ANOVA,and multiple linear regression analysis.Results1.At T1 269 patients were included;at T2 and T3,no study subjects were lost,both 269;at T4 30 were lost,an attrition rate of 11.2%.The mean age of the study subjects was 60.68±4.10 years,with an age range of 50 to 79 years.2.Comparison of the characteristics of the lost sample with those of the non-lost subjects showed that the main characteristics of the lost compared to the non-lost were:living in cities and towns,smoking,higher cardiac function class,abnormal preoperative fasting glucose,normal postoperative haemoglobin level,abnormal postoperative albumin level and abnormal postoperative neutrophil level(P<0.05).All other characteristics and PHQ-9 score(T1-T3 depression)were not significantly different(P>0.05).3.The results of LCGA analysis showed that three subgroups of a subgroup of heterogeneous trajectories of depressive symptoms,namely,the "moderately elevated depressive symptoms fluctuation group"(patients with low initial levels of depressive symptoms,gradually fluctuating over time to reach moderate levels of depressive symptoms,accounting for 21.7%),the "mildly elevated depressive symptoms postoperatively group"(patients with low depressive symptoms except for mildly elevated depressive symptoms at T2,accounting for 72.4%),and the "persistent remission of depressive symptoms group"(patients with high initial depressive symptoms and slowly decreasing depressive symptoms over time,accounting for 5.9%).4.The mean score of the total quality 3 months after discharge(T4)was 86.16±19.98,the mean score of physical function was 41.46±10.64,the mean score of mental function was 44.7±10.77,and the mean score of frailty was 1.27±1.11.5.Predictive effect of heterogeneous trajectory of perioperative depressive symptoms on patients’ quality of life 3 months after discharge:After controlling for statistically significant socio-demographic characteristics and disease-related information in the univariate analysis,the "moderately elevated depressive symptoms fluctuation group" negatively predicted patients’total score of quality of life 3 months after discharge compared to the "mildly elevated depressive symptoms postoperatively group"(β=-0.581,t=-11.280,P<0.001),the score of physical functioning dimension(β=-0.544,t=-10.333,P<0.001)and the score of mental function(β=-0.545,t=-10.333,P<0.001).6.Predictive effect of heterogeneous trajectory of perioperative depressive symptoms on patients’ frailty 3 months after discharge:After controlling for statistically significant sociodemographic characteristics and disease-related information in univariate analysis,the"moderately elevated depressive symptoms fluctuation group" compared to the "mildly elevated depressive symptoms postoperatively group" positively predicted the score of frailty 3 months after discharge(β=0.547,t=10.457,P<0.001).Conclusions1.Heterogeneous trajectories of perioperative depressive symptoms exist in middle-aged and elderly cardiac surgery patients,which can be divided into three trajectory subgroups:"moderately elevated depressive symptoms fluctuation group",the "mildly elevated depressive symptoms postoperatively group",and the "persistent remission of depressive symptoms group".2."Moderately elevated depressive symptoms fluctuation group" negatively predicted the score of total quality of life score,physical function and mental function dimensions of quality of life 3 months after discharge,and positively predicted the score of frailty 3 months after discharge.3.This study found that the "moderately elevated depressive symptoms fluctuation group"had a greater impact on patients’ post-discharge health status(quality of life and frailty),and this trajectory subgroup accounted for 21.7%of the total,suggesting that this group of patients should be given high attention in the future.