Abstract
BACKGROUND: Neuropsychiatric symptoms significantly impact surgical recovery, quality of life, and long-term survival. To investigate the association between intraoperative dexmedetomidine administration and the incidence of postoperative depressive symptoms in noncardiac surgical patients. METHODS: A multicenter prospective observational study of older surgical patients over 65 years of age from April 2020 to April 2022. The primary outcome was the incidence of postoperative 7-day depressive symptoms. Secondary outcomes were the incidence of postoperative 7-day anxiety symptoms, sleep disturbance, and delirium. A logistic regression model based on the random effect was used to determine the association between dexmedetomidine administration and the outcomes. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were employed to address data imbalance. Subgroup analyses based on specific populations were performed to explore the relationship between dexmedetomidine and depressive symptoms. RESULTS: Of 5591 patients, 20.5% (1148) received intraoperative dexmedetomidine. The incidence of postoperative 7-day depressive symptoms was significantly lower in the dexmedetomidine group compared to the nondexmedetomidine group (unadjusted: 7.6% vs. 26.7%, p < 0.001; PSM: 7.9% vs. 29.0%, IPTW: 8.7% vs. 25.8%, p < 0.001). Dexmedetomidine was significantly associated with the remission of postoperative 7-day depressive symptoms (adjusted random-effect model: risk ratio [RR] 0.104, 95% CI, 0.080-0.140, p < 0.001; PSM: RR 0.311, 95% CI, 0.242-0.415, p < 0.001; IPTW: RR 0.297, 95% CI, 0.253-0.343, p < 0.001). Additionally, dexmedetomidine demonstrated protective effects against postoperative anxiety symptoms, sleep disturbance, and delirium. In age, gender, cumulative comorbidity, frailty, ASA physical status, and inhaled anesthetic subgroups, we also found that dexmedetomidine was associated with a reduction in postoperative depressive symptoms in older noncardiac patients. CONCLUSION: Intraoperative dexmedetomidine administration was associated with a reduction in postoperative 7-day depressive symptoms, anxiety symptoms, sleep disturbances, and delirium in older patients undergoing noncardiac surgery. TRIAL REGISTRATION: The clinical trial protocol of this study was registered in the Clinical Trial registry (NCT06362408). PRIOR PRESENTATIONS: The authors have nothing to report.