Impact of New-Onset Postoperative Depression on Readmission Outcomes After Surgical Coronary Revascularization

Esteban Aguayo; Robert Lyons; Yen-Yi Juo; Katherine L Bailey; Young-Ji Seo; Vishal Dobaria; Yas Sanaiha; Peyman Benharash

doi:10.1016/j.jss.2018.07.062

Impact of New-Onset Postoperative Depression on Readmission Outcomes After Surgical Coronary Revascularization

J Surg Res. 2019 Jan:233:50-56. doi: 10.1016/j.jss.2018.07.062. Epub 2018 Aug 17.

Authors

Esteban Aguayo¹, Robert Lyons², Yen-Yi Juo², Katherine L Bailey¹, Young-Ji Seo¹, Vishal Dobaria², Yas Sanaiha², Peyman Benharash³

Affiliations

¹ David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
² Division of Cardiac Surgery, David Geffen School of Medicine, University of California at Los Angeles, UCLA Center for Health Sciences, Los Angeles, California.
³ Division of Cardiac Surgery, David Geffen School of Medicine, University of California at Los Angeles, UCLA Center for Health Sciences, Los Angeles, California. Electronic address: [email protected].

PMID: 30502287
DOI: 10.1016/j.jss.2018.07.062

Abstract

Background: Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. 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 on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery.

Methods: A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database. CABG patients who were readmitted more than 2 wk but within 90 d of discharge were categorized based on the presence of new-onset depression. Association between the development of new-onset depression and rehospitalization were morbidity, mortality, costs, and length of stay (LOS) and were examined using multivariable regression.

Results: During the study period, 1,001,945 patients underwent CABG. Of these, 11.7% of patients were readmitted after 14 d but within 90 d of discharge with 5.1% of these patients having a diagnosis of new-onset depression. Postoperative new-onset depression was not associated with increased readmission morbidity, costs, or LOS. Mortality in new-onset depression readmissions was 1.2%, compared with 2.3% in all readmitted patients (P = 0.014). Depression was associated with lower odds of mortality (OR = 0.56, P = 0.02).

Conclusions: New-onset depression following CABG discharge was not associated with increased odds of mortality, morbidity, costs, or increased LOS on readmission. Rather, new-onset depression is associated with decreased odds of readmission mortality. Overall, CABG readmissions are decreasing, whereas the rate of new-onset depression is slightly increasing. Implementation of routine depression screening tools in postoperative CABG care may aid in early detection and management of depression to enhance postoperative recovery and quality of life.

Keywords: CABG; Cardiac surgery; Coronary artery bypass graft surgery; Depression; National readmissions database; Postoperative depression.

MeSH terms

Aged
Coronary Artery Bypass / adverse effects*
Coronary Artery Bypass / psychology
Coronary Artery Disease / mortality
Coronary Artery Disease / psychology
Coronary Artery Disease / surgery*
Depression / diagnosis
Depression / epidemiology*
Depression / psychology
Female
Follow-Up Studies
Hospital Mortality
Humans
Incidence
Male
Patient Readmission / statistics & numerical data*
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology*
Postoperative Complications / psychology
Quality of Life
Retrospective Studies
Risk Factors
Time Factors