(Poster 105) Depression and Postoperative Complications in Older Prolapse Surgery Patients

Objectives: Depression is underrecognized, undertreated and associated with poor medical and surgical outcomes. There is a paucity of information on the relationship between depressive symptoms and postoperative complications in older urogynecologic patients. We aimed to evaluate the impact of depression on postoperative adverse events (AE) following pelvic organ prolapse (POP) surgery. We hypothesized that depressive symptoms are associated with postoperative AEs.

Methods: This is a secondary analysis of combined study cohorts primarily focused on perioperative neurocognitive disorders in women aged ≥60 years who underwent POP surgery at a large academic center. Exclusion criteria include prior neurocognitive disorder diagnosis, history of stroke/major neurologic disorder, and modified mini-mental status examination score < 84. We assessed preoperative depression symptoms using the short-form Geriatric Depression Scale (GDS-SF) two weeks pre- and postoperatively. GDS-SF scores greater than 5 denote concern for depression. Clinicodemographic data were abstracted from the electronic medical record. We created a composite measure for any depression, which consisted of the following criteria: history of depression diagnosis and/or GDS-SF score ≥5. Postoperative AEs, defined as any unintended deviation from the normal post-surgery course within 3 months post-surgery, were categorized using Clavien-Dindo classification. Associations between depression and postoperative AEs were analyzed with Chi-square (Fisher’s exact) tests for categorical variables and T-test (Mann-Whitney U) for continuous variables as appropriate.

Results: There were 250 patients included in this cohort with a mean±standard deviation (SD) age of 72.90±6.23 years and a mean±SD body mass index of 27.56±4.44 kg/m2 (Table 1). Median(IQR) modified mini-mental status score was 96(93-98). Median(IQR) baseline GDS-SF score was 1(0-2). There were 60 (24.0%) patients who met the composite of any depression, of which 44 (17.6%) had a pre-existing history of depression and 24 (9.7%) had a baseline GDS-SF score suggestive of depression. Seventy-seven (30.8%) patients underwent laparoscopic/robotic apical prolapse repair, and 173 (69.2%) underwent vaginal prolapse repair. The majority (233 (93.2%)) underwent general anesthesia. Median (IQR) length of stay was 0.7(0.6-0.8) days. There were 141 (56.4%) women who experienced postoperative AEs. The majority of postoperative AEs were grade I or II.
In this cohort, any depression was not associated with postoperative AEs (p=0.80). GDS-SF ≥ 5 score nor history of depression alone were associated with postoperative AEs (p=0.51, p=0.54). Serious postoperative AEs (≥CD Grade III) and any depressive symptoms were not associated with statistical significance (OR 4.95, 95% CI 0.81-30.3).

Conclusions: This study analysis does not demonstrate association between depressive symptoms and postoperative AEs in older women undergoing prolapse surgery. This study is limited due to a short endpoint of 3 months post-surgery and small sample size. Further research with longer postoperative follow-up intervals is needed.