The association between preoperative telomere length and acute postoperative depression: a single-center prospective observational pilot study

Background We hypothesized that a shorter preoperative leukocyte telomere length (TL) predicts the development of acute postoperative depression in elderly surgical patients.Methods This single-center, prospective, observational study included 48 patients ≥ 65 years old requiring intensive care unit admission for ≥ 2 days after surgery. Acute postoperative depression was defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 on postoperative day 7. Multivariate logistic regression analyses were performed to determine whether the preoperative TL could be used to predict the development of acute postoperative depression.Results 48 patients who underwent esophagectomy, head and neck surgery, or off-pump coronary bypass grafting were included. 20 patients (41.7%) developed acute postoperative depression. The preoperative TL was not significantly different between the depression group and the non-depression group (n = 28) (303,902 ± 48,103 vs. 331,816 ± 48,984 RLU/µg DNA, p = 0.056). The multivariable logistic regression analysis showed that the surgical procedure type was the dominant predictor of acute postoperative depression, whereas preoperative TL was not independently associated (OR 1.585, 95%CI: 0.722-3.479, p = 0.251). In a post-hoc subgroup analysis excluding head & neck surgery patients, the preoperative TL was significantly shorter in the depression group (302,990 ± 38,881 vs. 336,426 ± 49,755 RLU/µg DNA, p = 0.042) and was independently associated with acute postoperative depression after adjustment for the surgical procedure type (OR 3.556, 95%CI: 1.121-11.282, p = 0.031).Conclusions There was no significant association between the preoperative TL and acute postoperative depression. This result may be due to the small sample size and a cohort comprising multiple surgical procedure types. The exploratory post-hoc subgroup analysis excluding the patients who underwent head & neck surgery showed that shorter preoperative TL was significantly associated with an increased risk of acute postoperative depression. However, this preliminary finding is hypothesis-generating rather than confirmatory and should be interpreted with caution.Trial registration jRCT1020220041.