Permissive hypercapnia combined with goal-directed fluid therapy improve postoperative mental health in elderly patients undergoing laparoscopic surgery

Table 1 Baseline demographic and clinical characteristics

Characteristic	Study group (n = 60)	Control group (n = 60)	P value
Age (year), mean ± SD	71.3 ± 5.2	70.8 ± 5.5	0.65
Gender (male/female)	34/26	32/28	0.78
BMI (kg/m2)	23.5 ± 2.8	23.8 ± 2.6	0.54
ASA classification distribution	I: 10, II: 30, III: 20	I: 12, II: 32, III: 16	0.89
Tumor staging	I: 10, II: 20, III: 20, IV: 10	I: 12, II: 22, III: 18, IV: 8	0.92
Comorbidities (n)	30	28	0.73
Smoking history (yes/no)	20/40	18/42	0.81
Alcohol consumption (yes/no)	15/45	12/48	0.76
Hypertension (yes/no)	25/35	23/37	0.85
Diabetes mellitus (yes/no)	12/48	10/50	0.79
Previous surgery (yes/no)	10/50	8/52	0.71
Family history of cancer (yes/no)	15/45	13/47	0.82
Chemotherapy history (yes/no)	5/55	3/57	0.75
Radiotherapy history (yes/no)	3/57	2/58	0.83

BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Enhanced recovery indicators

Indicator	Study group (n = 60)	Control group (n = 60)	P value
Time to first flatus (hours)	48.3 ± 6.2	62.5 ± 7.8	0.002
Time to ambulation (hours)	28.4 ± 4.2	38.6 ± 5.1	0.001
Length of hospital stay (days)	5.2 ± 1.1	7.4 ± 1.3	0.003
Postoperative pain score (0-10)	3.1 ± 1.2	4.5 ± 1.5	0.004
Time to first diet (hours)	36.2 ± 5.0	48.7 ± 6.3	0.001
Postoperative nausea and vomiting (yes/no)	10/50	20/40	0.012
Postoperative infection rate (%)	5.0 ± 2.2	10.0 ± 3.1	0.021
Postoperative complications (n)	8	15	0.034
Patient satisfaction score (0-10)	8.5 ± 1.0	7.0 ± 1.2	0.001

Table 3 Anxiety and depression scores

Indicator	Study group (n = 60)	Control group (n = 60)	P value
Anxiety score (mean ± SD)	5.2 ± 1.4	7.8 ± 1.6	0.001
Depression score (mean ± SD)	4.8 ± 1.2	7.1 ± 1.5	0.001
Patients with clinically significant anxiety (HAD score ≥ 7) (%)	15.0% (9/60)	35.0% (21/60)	0.008
Patients with clinically significant depression (HAD score ≥ 7) (%)	13.3% (8/60)	31.7% (19/60)	0.012
FOP score (mean ± SD)	3.5 ± 1.0	5.0 ± 1.2	0.002
FAB score (mean ± SD)	2.8 ± 0.9	4.2 ± 1.1	0.003
Psychological resilience score (mean ± SD)	7.5 ± 1.5	5.8 ± 1.4	0.001
PostopQRS score (mean ± SD)	85.2 ± 10.3	72.4 ± 12.1	0.001

FAB: Fear avoidance belief; FOP: Fear of pain; HAD: Hospital Anxiety and Depression; PostopQRS: Postoperative Quality of Recovery Scale.

Table 4 Inflammatory response analysis of inflammatory markers

Inflammatory marker	Study group (n = 60)	Control group (n = 60)	P value
IL-6 (pg/mL)	42.3 ± 8.5	68.7 ± 12.4	< 0.001
TNF-α (pg/mL)	28.4 ± 5.6	45.2 ± 8.9	< 0.001
CRP (mg/L)	38.5 ± 7.2	62.4 ± 11.3	< 0.001
IL-1β (pg/mL)	12.5 ± 3.4	18.7 ± 4.5	0.002
IL-10 (pg/mL)	15.2 ± 2.8	10.5 ± 2.1	0.001
MCP-1 (pg/mL)	20.3 ± 4.2	28.6 ± 5.8	0.003
IFN-γ (pg/mL)	9.8 ± 2.3	14.5 ± 3.7	0.004
S100A8 (ng/mL)	1.2 ± 0.3	2.1 ± 0.5	0.001

IL: Interleukin; TNF-α: Tumor necrosis factor α; CRP: C-reactive protein; MCP: Monocyte chemoattractant protein; IFN-γ: Interferon-gamma.

Table 5 Sleep quality assessment

Indicator	Study group (n = 60)	Control group (n = 60)	P value
Global PSQI score (mean ± SD)	5.2 ± 1.3	7.8 ± 1.8	0.002
Postoperative morphine equivalent consumption (mg)	15.3 ± 3.2	23.6 ± 4.5	0.001
Sleep latency (minutes)	20.4 ± 5.6	30.2 ± 7.1	0.003
Total sleep time (hours)	6.8 ± 1.2	5.4 ± 1.0	0.001
Sleep efficiency (%)	85.2 ± 6.3	72.4 ± 7.8	0.001
Sleep disturbances (n)	12	24	0.004
Use of sleep medication (yes/no)	5/55	15/45	0.012
Daytime dysfunction (n)	8	18	0.015
ESS score (mean ± SD)	4.5 ± 1.2	6.8 ± 1.5	0.001

PSQI: Pittsburgh Sleep Quality Index; ESS: Epworth Sleepiness Scale.

Table 6 Multivariate analysis of postoperative anxiety and depression

Risk factor	Variable	OR (95%CI)	P value
Postoperative anxiety (HAD-A ≥ 7)	PH + GDFT intervention	0.38 (0.24-0.62)	0.001
	Age ≥ 75 years	1.85 (1.32-2.59)	0.003
	IL-6 levels at 24 hours (pg/mL)	1.42 (1.18-1.71)	0.002
	PSQI > 5	2.13 (1.56-2.91)	< 0.001
	Postoperative complications	2.45 (1.73-3.46)	< 0.001
	Postoperative pain score (NRS)	1.25 (1.05-1.48)	0.012
	Duration of surgery (≥ 120 minutes)	1.60 (1.10-2.33)	0.015
Postoperative depression (HAD-D ≥ 7)	PH + GDFT intervention	0.41 (0.26-0.65)	0.001
	Age ≥ 75 years	1.78 (1.25-2.53)	0.002
	IL-6 levels at 24 hours (pg/mL)	1.35 (1.12-1.63)	0.003
	PSQI > 5	2.05 (1.48-2.84)	< 0.001
	Postoperative complications	2.30 (1.60-3.33)	< 0.001
	Postoperative pain score (NRS)	1.30 (1.08-1.56)	0.007
	Duration of surgery (≥ 120 minutes)	1.55 (1.08-2.22)	0.018

OR: Odds ratio; CI: Confidence interval; HAD: Hospital Anxiety and Depression; PH: Permissive hypercapnia; GDFT: Goal-directed fluid therapy; IL: Interleukin; PSQI: Pittsburgh Sleep Quality Index; NRS: Numeric rating scale.