Surgical endoscopy · 2026
Impact of preoperative depression severity and antidepressant medication use on perioperative outcomes and long-term weight loss following primary bariatric surgery.
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Maric Emil, Wang Colin, Zukancic Selma, Kuchta Kristine, Amundson Julia R, Rolnik Ashley, Hedberg Herbert Mason, Linn John, Denham Ervin Woody, Ujiki Michael, Liu Natalie
Аннотация
BACKGROUND: Depression affects up to half of bariatric surgery candidates, yet the impact of depression severity and preoperative antidepressant pharmacotherapy use on surgical outcomes remains poorly characterized.
METHODS: This was a retrospective cohort study of patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between January 2018 and June 2024. Depression severity was stratified using PHQ-9 scores obtained during standard preoperative psychological evaluation. Antidepressant use was classified by pharmacologic class and number of concurrent medications. The primary outcome was percent excess body weight loss (%EBWL) at 6, 12, 24, 36, 48, and 60 months postoperatively. Secondary outcomes included 30-day perioperative complications, readmissions, and emergency department visits.
RESULTS: Of 930 patients identified, 128 (13.8%) carried a preoperative depression diagnosis. Patients with depression achieved significantly greater %EBWL at 6 months (46.9% vs. 43.1%, p = 0.026), 1 year (56.9% vs. 52.0%, p = 0.012), and 2 years (59.0% vs. 50.4%, p = 0.007) compared to those without depression, with no significant differences at later timepoints. Among patients with depression, those with none/minimal PHQ-9 severity had significantly greater %EBWL at 1 year compared to mild/moderate and moderately severe/severe groups (p = 0.031). No significant differences in 30-day perioperative complications were observed based on depression diagnosis or PHQ-9 severity category. However, patients with depression who were not taking antidepressants had significantly higher overall complication rates (11.5% vs. 0%, p = 0.002) and 30-day readmission rates (15.4% vs. 3.0%, p = 0.045) compared to those receiving antidepressant therapy.
CONCLUSIONS: Preoperative depression is not a contraindication to bariatric surgery; patients with depression can achieve excellent short-term weight loss, particularly in the first two postoperative years. Optimizing preoperative depression treatment appears to reduce perioperative morbidity and may confer a protective effect on perioperative outcomes in this population.
METHODS: This was a retrospective cohort study of patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between January 2018 and June 2024. Depression severity was stratified using PHQ-9 scores obtained during standard preoperative psychological evaluation. Antidepressant use was classified by pharmacologic class and number of concurrent medications. The primary outcome was percent excess body weight loss (%EBWL) at 6, 12, 24, 36, 48, and 60 months postoperatively. Secondary outcomes included 30-day perioperative complications, readmissions, and emergency department visits.
RESULTS: Of 930 patients identified, 128 (13.8%) carried a preoperative depression diagnosis. Patients with depression achieved significantly greater %EBWL at 6 months (46.9% vs. 43.1%, p = 0.026), 1 year (56.9% vs. 52.0%, p = 0.012), and 2 years (59.0% vs. 50.4%, p = 0.007) compared to those without depression, with no significant differences at later timepoints. Among patients with depression, those with none/minimal PHQ-9 severity had significantly greater %EBWL at 1 year compared to mild/moderate and moderately severe/severe groups (p = 0.031). No significant differences in 30-day perioperative complications were observed based on depression diagnosis or PHQ-9 severity category. However, patients with depression who were not taking antidepressants had significantly higher overall complication rates (11.5% vs. 0%, p = 0.002) and 30-day readmission rates (15.4% vs. 3.0%, p = 0.045) compared to those receiving antidepressant therapy.
CONCLUSIONS: Preoperative depression is not a contraindication to bariatric surgery; patients with depression can achieve excellent short-term weight loss, particularly in the first two postoperative years. Optimizing preoperative depression treatment appears to reduce perioperative morbidity and may confer a protective effect on perioperative outcomes in this population.