Association of preoperative anxiety and depression with quality of recovery after caesarean delivery: a prospective observational study

Abstract

Abstract Introduction To investigate the association between the presence of both anxiety and depression and the quality of recovery after caesarean delivery. Methods This secondary analysis of a prospective observational study included 137 patients aged ≥ 18 years who underwent elective and urgent caesarean delivery under spinal anesthesia and completed the Obstetric Quality of Recovery-11 scale at least once postoperatively. Before caesarean delivery, patients were screened for anxiety and depression using the Hospital Anxiety and Depression Scale. A total score of ≥ 8 in each subscale was considered positive screening. Postpartum quality of recovery was assessed using the Obstetric Quality of Recovery-11 at three time points, with a higher score indicating better recovery. Results Among the eligible patients, 17.5% (24/137) screened positive for both anxiety and depression. No significant difference was found in the Obstetric Quality of Recovery-11 score 24 h after caesarean delivery (p = 0.13, Cohen’s d = 0.33), but differences were observed on postoperative day 3 (p = 0.004, Cohen’s d = 0.67) and postoperative day 5 (p = 0.01, Cohen’s d = 0.58). In the multiple regression analysis, after adjusting for prominent clinical factors, the presence of both anxiety and depression was associated with the Obstetric Quality of Recovery-11 score on postoperative day 3 (p = 0.01) and postoperative day 5 (p = 0.01), but not 24 h after delivery (p = 0.19). Conclusions Positive Hospital Anxiety and Depression Scale screening for both anxiety and depression was associated with a poor quality of recovery, measured using the Obstetric Quality of Recovery-11 scores on PODs 3 and 5.

Keywords

• Anxiety
• Caesarean delivery
• Depression
• Patient-reported outcome measures