E. A. Aguayo1, Y. Juo1, Y. Seo1, K. L. Bailey1, V. Dobaria1, Y. Sanaiha1, P. Benharash1 1University Of California – Los Angeles,Department Of Surgery/ Division Of Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Postoperative depression affects between 10-40% of patients after cardiac operations and is associated with significantly worse cardiovascular outcomes. Indeed, depression screening has been recommended in the care of patients undergoing cardiac operations. While its exact causes are unknown, the incidence and impact of new onset depression beyond acute follow up remain ill defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression during 90-day readmission after coronary artery bypass surgery (CABG).
Methods:
A retrospective cohort study was performed identifying patients with no prior depression who received CABG using the 2010-2014 National Readmissions Database (NRD). Adult CABG patients who were readmitted within 90 days of discharge were categorized based on the presence of new-onset depression. Association between development of postoperative depression and mortality/complications during rehospitalization was examined using logistic regression models, adjusting for comorbid conditions. In-hospital mortality and GDP-adjusted costs were evaluated using hierarchical linear models and comorbidity via the Elixhauser Index.
Results:
A total of 423,455 patients without prior diagnosis of depression were identified as undergoing CABG during the study period. Nationally, 18.9% of patients were readmitted within 90 days of index discharge, of which 5.6% developed new-onset depression. Within the readmitted cohort, risk factors for new-onset depression included female gender (OR=1.45, 95% CI: 1.33-1.57, p<0.01), experiencing a surgery-related complication (OR=1.18, 95% CI: 1.03-1.34, p=0.01), prolonged stay during index stay (OR=1.23, 95% CI: 1.12-1.35, p<0.01) and being discharged to locations other than home (OR=1.61, 95% CI: 1.48-1.76, p<0.01). Postoperative depression was independently associated with elevated odds of systemic complication during readmission (OR=1.17, 95% CI: 1.09-1.27, p<0.01), prolonged hospital stay (OR=1.61, 95% CI: 1.42-1.82, p<0.01), discharge to disposition other than home (OR=1.51, 95% CI: 1.35-1.69, p<0.01) and higher hospitalization costs (coefficient $906.1, 95% CI: 130.9-1681.3, p=0.02). The overall mortality during readmission was 2.6% while new-onset depression was associated with lower odds of death after adjusting for baseline differences (OR=0.56, 95% CI: 0.42-0.74, p<0.01).
Conclusions:
New-onset of depression following discharge CABG was associated with significantly worse outcomes during rehospitalization. The results of this national study supports institution of psychiatric evaluation and measures to reduce the development of depression following cardiac operations. Programs to incorporate early detection and timely management of depression may reduce systemic complications during readmission and enhance quality of care and postoperative recovery.