PREOPERATIVE DEPRESSION AND ANXIETY AS PREDICTORS OF POSTOPERATIVE.pptx

It is a short presentation on my thesis regarding depression and anxiety with poor surgical outcomes

1. PREOPERATIVE DEPRESSION AND ANXIETY AS PREDICTORS OF POSTOPERATIVE C-REACTIVE PROTEIN LEVELS IN PATIENTS UNDERGOING CARDIAC SURGERY -DR.SANJAYA BHARATHI.V.P. THESIS GUIDE:DR.KAPPIAN SIR

2. INTRODUCTION C-REACTIVE PROTEINS(CRP) are acute phase reactants produced by the liver .The level of CRP rises when there is inflammation in the body in response to cytokines .Most healthy adults have CRP levels below 0.3 mg/dl. Surgeries induce systemic inflammatory response , thus increasing CRP levels .CRP levels more than 10mg/dl are considered as significant elevation and they achieve peak levels in POD-2,3 and return to pre-op levels within 3 weeks of surgery. Post-op CRP levels are of prognostic value . In a study conducted on patients who underwent CABG,maximum CRP levels on POD 1-3 predicted an increased risk of major adverse cardiovascular and cerebral events after a 2 yr followup . In patients undergoing cardiac surgery , prevalence of depression ranges from 14% to 37% and anxiety before surgery ranges from 7% to 40% based on various studies.

3. Preoperative depression and anxiety have been associated with increased risk of fatal and nonfatal major cardiac events like arrhythmias,graft disease progression,angina,etc ., The pathophysiology behind depression,anxiety and cardiovascular outcomes is still idiopathic.However multiple studies have shown that baseline crp levels increase( upto 3 mg/dl) with clinically relevant depression and anxiety and post-op crp elevation in patients with preoperative depression and anxiety has been significantly more than that of non depressed patients. Hence,preoperative depression and anxiety could be used as independent predictors of significant postop CRP elevation and possible interventions could be planned to prevent adverse cardiovascular events. Clinically significant depression and anxiety can be identified using patient self rated questionnaires PHQ-9 and GAD-7

4. AIM To determine if preoperative depression and anxiety can be used to predict post operative crp levels in cardiac surgery patients. INCLUSION CRITERIA AGE 18 AND ABOVE ASA GRADE 1,2,3 AND 4 PATIENTS UNDERGOING CARDIAC SURGERY

5. EXCLUSION CRITERIA Patient refusal NON CARDIAC SURGERIES AGE BELOW 18 YEARS ASA 5 AND 6 PATIENT ILLITERACY AND ANY OTHER CONDITIONS THAT PREVENT PATIENT FROM FILLING THE QUESTIONNAIRES

6. Patient health questionnaire -9

7. General anxiety disorder-7 questionnaire

8. CRP levels will be measured on four occasions: Preop baseline CRP on day before surgery POD-2 AND POD-3 DAY OF DISCHARGE THANK YOU