Preoperative depressive symptoms as a marker of postoperative delirium risk in older adults: a prospective cohort study in spine surgery

Introduction Postoperative delirium (POD) is a frequent perioperative complication in older adults and is associated with delayed recovery and adverse cognitive outcomes. We investigated whether preoperative depressive and anxiety symptoms were associated with POD in adults aged 60 years or older undergoing elective spine surgery. Methods This prospective cohort analysis was conducted within the Cognitive Dysfunction Following Elective Spine Surgery in Older Patients (CONFESS) study. Depressive and anxiety symptoms were assessed preoperatively using the Hospital Anxiety and Depression Scale. POD was screened using the Nursing Delirium Screening Scale and confirmed by a physician according to DSM-5 criteria. Results Of 124 enrolled patients, 99 participants underwent surgery and 93 had complete data for the present analysis (mean age 71.2 ± 7.1 years; 45 women). Sixteen patients (17.2%) developed POD. Each one-point increase in the depression subscale score was associated with higher odds of POD (odds ratio 1.29, 95% confidence interval 1.06–1.55; p = 0.01). A depression subscale score of 8 or higher was associated with sixfold higher odds of POD (odds ratio 6.00, 95% confidence interval 1.86–19.32; p < 0.01). The continuous association remained significant after adjustment for age, sex, and preoperative cognitive performance (adjusted odds ratio 1.25, 95% confidence interval 1.03–1.52; p = 0.03). Anxiety symptoms were not significantly associated with POD. Discussion Preoperative depressive symptom burden was associated with POD after adjustment for age, sex, and preoperative cognitive performance. Given the limited number of POD events, these findings should be interpreted cautiously but may support further evaluation of depressive symptom screening as an adjunct to perioperative geriatric risk stratification. Clinical Trial registration This study was prospectively registered on 1 March 2018 via ClinicalTrials.gov (ID: NCT03486288).