Correlation between patient health questionnaire-2 and postoperative pain in laparoscopic cholecystectomy

Abstract

Background: Postoperative pain is affected by preoperative depression. If the risk of postoperative pain associated with depression can be predicted preoperatively, anesthesiologists and/or surgeons can better manage it with personalized care. The objective of this study was to determine the efficacy of Patient Health Questionnaire-2 (PHQ-2) depression screening tool as a predictor of postoperative pain. Methods: A total of 50 patients scheduled for elective laparoscopic cholecystectomy with an American Society of Anesthesiologists grade of 1 or 2 were enrolled. They answered the PHQ-2, which consists of two questions, under the supervision of a researcher on the day before the surgery. The numerical rating scale (NRS) scores were assessed at post-anesthesia care unit (PACU), at 24, and 48 postoperative hours, and the amount of intravenous patient-controlled analgesia (IV-PCA) administered was documented at 24, 48, and 72 postoperative hours. At 72 h, the IV-PCA device was removed and the final dosage was recorded.Results: The NRS score in PACU was not significantly associated with the PHQ-2 score (correlation coefficients: 0.13 [P = 0.367]). However, the use of analgesics after surgery was higher in patients with PHQ-2 score of 3 or more (correlation coefficients: 0.33 [P = 0.018]).Conclusions: We observed a correlation between the PHQ-2 score and postoperative pain. Therefore, PHQ-2 could be useful as a screening test for preoperative depression. Particularly, when 3 points were used as the cut-off score, the PHQ-2 score was associated with the dosage of analgesics, and the analgesic demand could be expected to be high with higher PHQ-2 scores.

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“…The PHQ-2 questionnaire consists of two questions that measure the symptoms of depression: “Little interest or pleasure in doing things” and “Feeling down, depressed, or hopeless.” The possible responses are “Not at all,” “Several days,” “More than half the days,” and “Nearly every day.” Each question is scored from 0 to 3, and the total score is the sum of both questions. A score of ≥3 indicates a high likelihood of major depressive disorder [20, 21].…”

“…We dichotomized age and CCI into two groups (<75 vs. ≥75 and <6 vs. ≥6) following previous studies [23][24][25]. Moreover, six screening tools (ECOG-PS, fTRST, G8, IADL, PHQ-2, and SARC-F), selected based on previous reports [8][9][10][11][12][13][14][15][16][17][18][19][20][21], were scored as shown below.…”

“…Each question is scored from 0 to 3, and the total score is the sum of both questions. A score of ≥3 indicates a high likelihood of major depressive disorder [20,21].…”

“…The patient health questionnaire-2 (PHQ-2) is a 2-item questionnaire that asks about the frequency of depressed mood and anhedonia and is used as a screening test for depression derived from the patient health questionnaire-9 (PHQ-9) [19]. The PHQ-2 is not originally a geriatric screening tool, but it is sometimes used in perioperative patients: it has been suggested that the PHQ-2 is associated with postoperative patient pain, satisfaction, and return to work [20,21].…”