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Depression in older surgical patients: a multicentre prospective longitudinal study. BACKGROUND: A longitudinal examination of postoperative depression is important for risk assessment. We aimed to explore the prevalence and trajectory of depression in older surgical patients, before surgery, and at 30, 90, and 180 days after surgery, associated risk factors, and clinical outcomes. METHODS: This prospective cohort study assessed 307 male and female surgical patients aged ≥65 yr in two preoperative clinics in Canada. All participants completed an online survey before and after surgery that contained the 15-item Geriatric Depression Scale with a ≥5 cut-off to define depression. We also assessed risk factors and clinical and patient-centred outcomes associated with depression. RESULTS: Preoperative depression was present in 20.2% (95% confidence interval [CI]: 16.1-25.1) of participants and 17.6% had potentially unrecognised depression. Overall, 18.7% (95% CI: 14.1-24.3) reported depression at 180 days after surgery. Participants with preoperative cognitive impairment (odds ratio [OR]: 2.91, 95% CI: 1.29-6.61, P=0.010) and sleep disturbances (OR: 2.91, 95% CI: 1.29-7.07, P=0.013) each had three-fold higher odds of preoperative depression. Those with preoperative functional disability had four-fold higher odds of preoperative depression (OR: 4.15, 95% CI: 1.58-11.54, P=0.005) and six-fold higher odds of depression at 180 days after surgery (OR: 5.91, 95% CI: 1.43-29.07, P=0.019). The depression group had 2.5-fold higher odds for non-home discharge (OR: 2.40, 95% CI: 1.08-5.10, P=0.026). CONCLUSIONS: The prevalence of depression was 20.2% before surgery and 18.7% at 180 days after surgery. Our findings highlight the interconnectedness of mental health with factors such as function, cognition, and sleep.