Work

Perioperative esketamine exposure and postoperative depression and anxiety in elderly patients undergoing joint replacement surgery: a retrospective cohort study

Year: 2026

Type: article

Abstract: Postoperative depression and anxiety are common in elderly patients undergoing joint replacement surgery and may affect recovery. Esketamine has rapid antidepressant effects, but evidence for combined perioperative use remains limited, particularly in elderly patients undergoing joint replacement surgery. This study evaluated the association between combined perioperative esketamine exposure and postoperative psychological outcomes and related biomarkers. This single-center retrospective cohort study included 60 elderly patients (65–80 years) undergoing unilateral hip or knee joint replacement surgery. Patients were categorized into an esketamine exposure group ( n = 30) and a non-esketamine group ( n = 30). The primary outcomes were postoperative depressive and anxiety symptom severity assessed using the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) at baseline (T0), postoperative day 3 (T3), and postoperative day 7 (T7). Pain was evaluated using the Visual Analogue Scale (VAS). Serum IL-6, TNF-α, and BDNF levels at T0, T3, and T7 were obtained from existing research records. Mixed-effects and multivariable regression analyses were performed. Baseline characteristics were comparable between groups ( P > 0.05). The esketamine exposure group showed significantly lower HAMD and HAMA scores at T3 and T7 ( P < 0.05). IL-6 and TNF-α levels were lower at T3 ( P < 0.05), while BDNF levels were higher at T3 and T7 ( P < 0.01). No significant differences were observed in VAS scores or adverse events ( P > 0.05). Multivariable analysis showed that combined perioperative esketamine exposure was independently associated with lower postoperative psychological scores. This study suggests that combined perioperative esketamine exposure was associated with lower postoperative depression and anxiety scores, accompanied by transient reductions in inflammatory cytokines and increased serum BDNF levels, without an increased incidence of adverse events. Prospective multicenter randomized controlled studies are warranted to confirm these findings. Not applicable.

Source: BMC Anesthesiology

DOI: 10.1186/s12871-026-04199-8

Authors: Mao Li, Wen Wen, Xiang Wen

Institution: Affiliated Hospital of North Sichuan Medical College

Language: English

Topic: Treatment of Major Depression

Subfield: Pharmacology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,190