Goal-directed fluid therapy and cognitive outcomes in elderly surgical patients with anxiety and depression

doi:10.5498/wjp.117251

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Jul 19, 2026; 16(7): 117251
Published online Jul 19, 2026. doi: 10.5498/wjp.117251

Goal-directed fluid therapy and cognitive outcomes in elderly surgical patients with anxiety and depression

Hui Li, Jin-Liang Teng, Li Yuan, Lei Han

Hui Li, Lei Han, Department of Anesthesiology, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China

Jin-Liang Teng, Li Yuan, Department of Anesthesiology, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China

Co-corresponding authors: Li Yuan and Lei Han.

Author contributions: Li H performed the statistical analysis and drafted the manuscript; Li H and Teng JL collected and organized the clinical data; Li H and Han L conceived and designed the study; Teng JL and Yuan L critically reviewed and revised the manuscript for important intellectual content; Yuan L and Han L supervised the study design and methodology as co-corresponding authors; Han L provided overall project supervision; all authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.

AI contribution statement: AI-assisted tools (ChatGPT and DeepSeek) were used solely for language translation and linguistic refinement to improve the clarity and readability of the manuscript. These tools did not contribute to the generation of scientific ideas, research content, data analysis, image creation, or any experimental or computational procedures. All study design, data collection, data interpretation, and scientific conclusions were completed entirely by the authors.

Supported by the Zhangjiakou Municipal Bureau of Science and Technology, No. 2311041D.

Institutional review board statement: The study protocol was reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Hebei North University, No. K2023137.

Informed consent statement: This was a retrospective cohort study based on anonymized clinical data. The requirement for written informed consent was waived by the Medical Ethics Committee of the First Affiliated Hospital of Hebei North University.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.

Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Lei Han, Chief Physician, Department of Anesthesiology, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, No. 3 Yongding Road East Street, Haidian District, Beijing 100039, China. lee91192025@163.com

Received: December 9, 2025
Revised: January 16, 2026
Accepted: March 24, 2026
Published online: July 19, 2026
Processing time: 201 Days and 6.8 Hours

Abstract

BACKGROUND

Postoperative cognitive dysfunction (POCD) occurs in 10%-40% of elderly surgical patients, severely impacting quality of life and increasing healthcare costs. Anxiety and depression, present in 30%-50% of perioperative patients, are independent risk factors for POCD through mechanisms including hippocampal damage, impaired cerebrovascular autoregulation, chronic inflammation, and neurotransmitter imbalances. Goal-directed fluid therapy (GDFT) has been proven to reduce POCD incidence by optimizing tissue perfusion. Patients with anxiety and depression, due to compromised cerebrovascular autoregulation and reduced hemodynamic tolerance, may particularly benefit from GDFT. However, research on GDFT’s cognitive protective mechanisms through improving cerebral oxygen supply-demand balance in this population remains limited.

AIM

To investigate the effects of GDFT on perioperative cerebral oxygen supply-demand balance in elderly surgical patients with comorbid anxiety and depression, and to evaluate its protective effects against POCD and its correlation with psychological status improvement.

METHODS

A retrospective cohort study was conducted, enrolling 220 elderly patients who underwent elective major abdominal or orthopedic surgery under general anesthesia at our hospital from April 2023 to March 2025. Patients were divided into the GDFT group and conventional fluid therapy (CFT) group, with 110 patients in each group, based on fluid management strategy. Preoperative psychological status was assessed using the Hospital Anxiety and Depression Scale. Regional cerebral oxygen saturation (rSO₂) was monitored perioperatively. Cognitive function was evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment on postoperative day (POD) 1, POD3, and POD7. Changes in cerebral oxygen saturation, POCD incidence, and anxiety-depression scores were compared between the two groups, and the correlation between cerebral oxygen supply-demand balance and cognitive function was analyzed.

RESULTS

The GDFT group demonstrated significantly smaller intraoperative rSO₂ decline compared with the CFT group (9.8% ± 4.2% vs 16.9% ± 6.5%, P < 0.001), with a lower incidence of cerebral oxygen supply-demand imbalance (29.1% vs 56.4%, P < 0.001). The incidence of POCD on POD1 was significantly lower in the GDFT group than in the CFT group (20.9% vs 38.2%, P = 0.005). Subgroup analysis revealed that the protective effect of GDFT was more pronounced in patients with comorbid anxiety and depression, with an absolute reduction of 22.1% in POCD incidence. Multivariable regression analysis identified preoperative anxiety and depression [adjusted odds ratio (OR) = 2.68], fluid therapy modality (adjusted OR = 2.12), and magnitude of rSO₂ decline (adjusted OR = 1.43 per 5% increase) as independent risk factors for POCD. Patients with anxiety and depression in the GDFT group showed more significant improvement in postoperative psychological status, and the degree of improvement was negatively correlated with POCD incidence.

CONCLUSION

GDFT was associated with a reduced incidence of POCD in elderly patients by improving perioperative cerebral oxygen supply-demand balance, with this protective effect being particularly prominent in patients with comorbid anxiety and depression. GDFT appeared to facilitate cognitive function recovery and psychological status improvement, highlighting the importance of integrated perioperative psychological-cognitive management.

Keywords: Goal-directed fluid therapy; Postoperative cognitive dysfunction; Cerebral oxygen saturation; Anxiety and depression; Elderly patients

Core Tip: This study demonstrates that goal-directed fluid therapy significantly improves perioperative cerebral oxygen supply-demand balance and reduces postoperative cognitive dysfunction in elderly surgical patients. The protective effect is especially strong in patients with preoperative anxiety and depression, a high-risk population with impaired cerebrovascular regulation and altered oxygen metabolism. By stabilizing hemodynamics and preserving regional cerebral oxygen saturation, goal-directed fluid therapy promotes both cognitive recovery and improvements in psychological status, highlighting its value for precision perioperative brain protection.