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Observational Study
. 2020 Mar;121(4):676-687.
doi: 10.1002/jso.25836. Epub 2020 Jan 12.

The association of preoperative anxiety and depression with neurocognitive disorder following oncological surgery

Jing Du  1 , Matthijs Plas  2 , Anthony R Absalom  3 , Barbara L van Leeuwen  2 , Geertruida H de Bock  1
Affiliations
Observational Study

The association of preoperative anxiety and depression with neurocognitive disorder following oncological surgery

Jing Du et al. J Surg Oncol. 2020 Mar.

Abstract

Background: The proposed underlying mechanisms of anxiety and depression, and of postoperative neurocognitive disorder (NCD), each include immune system involvement. Therefore, the aims of this study were to investigate the incidence of postoperative NCD 3 months after surgery among oncological patients undergoing surgery and to evaluate the role of preoperative anxiety and depression.

Method: A consecutive series of patients (age ≥ 18 years) undergoing surgery for the removal of solid tumors were included (n = 218). Cognitive performance was assessed preoperatively and at 3 months postoperatively. Preoperative anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale.

Results: NCD affected 12.3% of elderly patients (age ≥ 70 years, n = 57) at 3 months after surgery, with executive function mostly affected. By contrast, 8.4% of younger patients (age < 70 years, n = 107) were affected, with information processing speed mostly affected. Low educational attainment was a risk factor (OR, 6.0; 95% CI, 1.9-19.0) of overall NCD, whereas preoperative anxiety was associated with decline in the domain of executive function.

Conclusion: Postoperative NCD is a complication of oncological surgery for all adults instead of the elderly only. Preoperative anxiety was associated with an increased risk of executive function decline, and low educational attainment was a key factor for overall NCD.

Keywords: cognitive dysfunction; depression; neoplasm; surgical procedure.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Flowchart from in‐ and excluded patients. Of the 218 included patients, 22 were excluded before surgery. Three months postoperatively 32 patients were excluded. The sample of current analysis included 164 patients
Figure 2
Figure 2
Cognitive decline at 3 months postoperatively. Data show the results of neurocognitive disorder overall and at the domain level as incidence (%) (95% confidence interval) [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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