SYSTEMATIC REVIEW article
Front. Psychiatry
Sec. Anxiety and Stress Disorders
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1628394
Meta-analysis of scar formation and depression and anxiety symptoms in patients after cardiac surgery
Provisionally accepted
- Yantai Yuhuangding Hospital, Yantai, China
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Background The vertical median skin scar associated with median sternotomy, a standard approach for most cardiac surgeries, can cause psychological distress in patients, particularly depression and anxiety. The impact of scarring after cardiac surgery on depression and anxiety symptoms in patients is not well understood. Aim The purpose of this meta-analysis was to investigate the effect of scarring on depressive and anxiety symptoms in patients after cardiac surgery. Methods To investigate the relationship between scar formation and depression and anxiety symptoms in patients after cardiac surgery. We searched databases such as Web of Science, Cochrane Library, PubMed, and Embase for studies published before August 2024 on scar descriptions and psychological states after cardiac surgery. After data extraction and quality assessment, we used RevMan5.4 to analyze the depression and anxiety symptoms of patients after scar formation. Two authors independently performed the focused analyses and reached a final consensus on the included studies, which were subsequently quality checked and risk of bias assessed by a third author. Results Four studies were included in the meta-analysis. All 4 studies used Patient and Observer Scar Assessment Scale (POSAS) to assess scar, and one study also combined Vancouver Scar Scale (VSS) for scar assessment. Meta-analysis results show that Full sternotomy has a smaller scar score than Limited sternotomy (OR=0.94 [95% confidence interval (CI) 0.28-1.61]; P=0.005), and there is no significant heterogeneity between the two groups (I2=0%). And the postoperative depression score in the Full sternotomy group was higher than that in the Limited sternotomy group (OR=1.61 [95%CI 0.63-2.60]; P=0.001), and there was no significant heterogeneity between the two groups (I2=0%). However, there was no statistical difference in postoperative anxiety scores between the two groups (OR=0.70 [95%CI 1.40-2.80]; P=0.51). There was slight heterogeneity between the two groups (I2=58%), so a random effects model was used. Conclusion In conclusion, patients with more severe scarring after cardiac surgery may have more severe depressive symptoms, but adequately powered randomized controlled trials are needed to confirm these results.
Keywords: Patient and Observer Scar Assessment, POSAS, Meta-analysis, Depression, Anxiety, SCARs
Received: 14 May 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Yuting, Liu and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lixin Lin, Yantai Yuhuangding Hospital, Yantai, China
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