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Li R, Ranganath B. Preoperative depression is an independent risk factor for short-term morbidities in autologous and implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2024; 95:190-198. [PMID: 38924897 DOI: 10.1016/j.bjps.2024.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/03/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Depression is notably common among patients who have undergone mastectomy. Several post-mastectomy patients opt for elective breast reconstruction. However, evidence on the influence of preoperative depression on breast reconstruction outcomes remains limited. This study aimed to evaluate the effect of preoperative depression on the short-term outcomes of autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) using a comprehensive national registry. METHODS Patients who underwent ABR or IBR were identified from the national inpatient sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between the patients with and without depression, adjusted for demographics, primary payer status, hospital characteristics, and comorbidities. RESULTS Among the 12,984 patients who underwent ABR, 1578 (12 %) had depression whereas 1980 (11 %) out of 17,963 patients who underwent IBR had depression. In ABR and IBR, preoperative depression was associated with higher superficial wound complications (ABR, aOR = 1.386, 95 % CI = 1.035-1.856, p = 0.03; IBR, aOR = 1.281, 95 % CI = 1.001-1.638, p = 0.04), hemorrhage/hematoma (ABR, aOR = 1.164, 95 % CI = 1.010-1.355, p = 0.04; IBR, aOR = 1.614, 95 % CI = 1.279-2.037, p < 0.01), and longer hospital length of stay (p < 0.01). In ABR, patients with depression had higher incidences of infection (aOR = 1.906, 95 % CI = 1.246-2.917, p < 0.01) and sepsis (aOR = 15.609, 95 % CI = 1.411-172.65, p = 0.03). In IBR, patients with depression had higher risks of capsular contracture (aOR = 1.477, 95 % CI = 1.105-1.976, p = 0.01) and seroma (aOR = 1.489, 95 % CI = 1.005-2.208, p = 0.04). CONCLUSION Preoperative depression is independently associated with major morbidities after ABR and IBR. Preoperative screening for depression can be beneficial. Findings from this study can facilitate preoperative risk stratification and post-operative care for patients with depression.
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Affiliation(s)
- Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Bharat Ranganath
- Department of Surgery, The George Washington University Hospital, Washington, DC, United States
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Vencloviene J, Beresnevaite M, Cerkauskaite S, Grizas V, Kriukelyte D, Benetis R. The short-term effect of weather variables on heart rate variability in patients after open-heart surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1357-1367. [PMID: 35704554 DOI: 10.1080/09603123.2022.2087864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
The aim of the study was to detect the associations between heart rate variability (HRV) and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The study was performed in Kaunas, Lithuania, during 2008-2012. We used data of 220 patients. HRV was assessed by a 5-minute electrocardiogram. The data were collected at 1.5 months, 1 year, and 2 years after the surgery (495 measurements). A negative association of standard deviation of beat-to-beat interval (SDNN), very low frequency (VLF), low frequency, and high frequency (HF) powers with a decrease in air temperature (T) during a 3-day period in the range of T < 1°C wind speed >2.75 knots 2 days before, and the daily North Atlantic Oscillation indices were observed. The effect of wind speed on SDNN and VLF power was stronger in males. Two days after relative humidity >89%, a lower mean VLF and higher HF in normalized units were found; in females, this effect was stronger 1.5 months after the surgery. Among patients after open-heart surgery, the HRV variables may be related to specific weather changes and the effect of weather was different for males and females and at different times after the surgery.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Sonata Cerkauskaite
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Vytautas Grizas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiva Kriukelyte
- Nursing Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Nursing Clinic, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Vu T, Smith JA. The pathophysiology and management of depression in cardiac surgery patients. Front Psychiatry 2023; 14:1195028. [PMID: 37928924 PMCID: PMC10623009 DOI: 10.3389/fpsyt.2023.1195028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background Depression is common in the cardiac surgery population. This contemporary narrative review aims to explore the main pathophysiological disturbances underpinning depression specifically within the cardiac surgery population. The common non-pharmacological and pharmacological management strategies used to manage depression within the cardiac surgery patient population are also explored. Methods A total of 1291 articles were identified through Ovid Medline and Embase. The findings from 39 studies were included for qualitative analysis in this narrative review. Results Depression is associated with several pathophysiological and behavioral factors which increase the likelihood of developing coronary heart disease which may ultimately require surgical intervention. The main pathophysiological factors contributing to depression are well characterized and include autonomic nervous system dysregulation, excessive inflammation and disruption of the hypothalamic-pituitary-adrenal axis. There are also several behavioral factors in depressed patients associated with the development of coronary heart disease including poor diet, insufficient exercise, poor compliance with medications and reduced adherence to cardiac rehabilitation. The common preventative and management modalities used for depression following cardiac surgery include preoperative and peri-operative education, cardiac rehabilitation, cognitive behavioral therapy, religion/prayer/spirituality, biobehavioral feedback, anti-depressant medications, and statins. Conclusion This contemporary review explores the pathophysiological mechanisms leading to depression following cardiac surgery and the current management modalities. Further studies on the preventative and management strategies for postoperative depression in the cardiac surgery patient population are warranted.
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Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia
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Vencloviene J, Beresnevaite M, Cerkauskaite S, Lopatiene K, Grizas V, Benetis R. The effects of weather on depressive symptoms in patients after cardiac surgery. PSYCHOL HEALTH MED 2023; 28:682-692. [PMID: 36203385 DOI: 10.1080/13548506.2022.2132411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Abstract
Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008-2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Sonata Cerkauskaite
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Lopatiene
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Grizas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Kaźmierski J, Miler P, Pawlak A, Jerczyńska H, Woźniak J, Frankowska E, Brzezińska A, Nowakowska K, Woźniak K, Krejca M, Wilczyński M. Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery. Sci Rep 2021; 11:23646. [PMID: 34880331 PMCID: PMC8655063 DOI: 10.1038/s41598-021-03007-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
Abstract
Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is also associated with a neuropsychiatric complications including postoperative delirium. The pathophysiology of delirium after cardiac surgery remains poorly understood. Thus, the purpose of this study was to investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant activity is independently associated with delirium after cardiac surgery. The second aim was to assess whether decreased antioxidant activity is stress-related or mediated by other pathologies such as major depressive disorder (MDD), anxiety disorders, and cognitive impairment. Furthermore, the putative relationship between pre- and postoperative soluble receptor for advanced glycation end-products (sRAGE) overexpression and plasma antioxidant capacity was evaluated. The patients cognitive status was assessed 1 day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of MDD and anxiety disorders was established on the basis of DSM-5 criteria. Blood samples for antioxidant capacity and sRAGE levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium was diagnosed in 34% (61 of 177) of individuals. Multivariate logistic regression analysis revealed that low baseline antioxidant capacity was independently associated with postoperative delirium development. Moreover, increased risk of delirium was observed among patients with a preoperative diagnosis of MDD associated with antioxidant capacity decreased postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative antioxidant capacity that predict the development of delirium were 1.72 mM and 1.89 mM, respectively. Pre- and postoperative antioxidant capacity levels were negatively correlated with postoperative sRAGE concentration (Spearman's Rank Correlation − 0.198 and − 0.158, p < 0.05, respectively). Patients with decreased preoperative antioxidant activity and those with depressive episodes complicated with lower postoperative antioxidant activity are at significantly higher risk of delirium after cardiac surgery development. sRAGE overexpression may be considered as protective mechanism against increased oxidative stress and subsequent cell damage.
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Affiliation(s)
- Jakub Kaźmierski
- Department of Old Age Psychiatry and Psychotic Disorders, Faculty of Gerontology, Medical University of Lodz, Czechoslowacka 8/10, 92-216, Lodz, Poland.
| | - Piotr Miler
- Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Pawlak
- Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
| | - Hanna Jerczyńska
- CoreLab Central Scientific Laboratory of Medical University of Lodz, Medical University of Lodz, Lodz, Poland
| | - Joanna Woźniak
- Department of Old Age Psychiatry and Psychotic Disorders, Faculty of Gerontology, Medical University of Lodz, Czechoslowacka 8/10, 92-216, Lodz, Poland
| | - Emilia Frankowska
- Department of Old Age Psychiatry and Psychotic Disorders, Faculty of Gerontology, Medical University of Lodz, Czechoslowacka 8/10, 92-216, Lodz, Poland
| | | | - Karina Nowakowska
- Department of Old Age Psychiatry and Psychotic Disorders, Faculty of Gerontology, Medical University of Lodz, Czechoslowacka 8/10, 92-216, Lodz, Poland
| | - Katarzyna Woźniak
- Department of Cardiac Surgery, Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
| | - Michał Krejca
- Department of Cardiac Surgery, Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
| | - Mirosław Wilczyński
- Department of Cardiac Surgery, Central Clinical Hospital, Medical University of Lodz, Lodz, Poland
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Tomer N, Small A, Mirza O, Palese M. Evidence of Resilience in Kidney Donors: A New York Statewide Cohort Analysis. Transplant Proc 2021; 53:803-807. [PMID: 33551185 DOI: 10.1016/j.transproceed.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Donor nephrectomy (DN) is a procedure performed to provide recipients with a kidney to treat end-stage renal disease. The following analysis evaluated depression diagnosis in DN patients compared to controls. METHODS DN patients and matched controls were identified between 2000 and 2009 from the Statewide Planning and Research Cooperative System database. Cohorts were tracked for depression incidence. Multivariable logistic regression was used to determine independent predictors of a postoperative depression diagnosis. RESULTS The total study cohort included 2108 DN cases and 2108 controls. In both donors and controls, the baseline rate of depression was 0.95% (n = 20). The 5-year incidence of depression diagnosis after exposure increased in both cohorts (donors: 2.5%, n = 53; controls: 7.2%, n = 152; P < .001). The 5-year relative risk for developing depression was 2.65 (CI 1.59-4.42, P = .0002) in donors and 7.60 (CI 4.79-12.07, P < .001) in controls. On multivariable regression, being a donor was associated with reduced risk of developing postoperative depression (OR = 0.322, CI 0.233-0.445, P < .001), and the greatest risk factor for postoperative depression was a prior depressive diagnosis (OR = 7.811, CI 3.814-15.997, P < .001). CONCLUSION Our analysis shows that the strongest risk factor for depression was a prior diagnosis of depression. However, willingness to undergo donor nephrectomy is associated with less subsequent depression than the control population, suggesting that kidney donors may be a more resilient cohort.
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Affiliation(s)
- Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Omar Mirza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Correa-Rodríguez M, Abu Ejheisheh M, Suleiman-Martos N, Membrive-Jiménez MJ, Velando-Soriano A, Schmidt-RioValle J, Gómez-Urquiza JL. Prevalence of Depression in Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E909. [PMID: 32225052 PMCID: PMC7230184 DOI: 10.3390/jcm9040909] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023] Open
Abstract
Coronary artery bypass graft surgery (CABG) might adversely affect the health status of the patients, producing cognitive deterioration, with depression being the most common symptom. The aim of this study is to analyse the prevalence of depression in patients before and after coronary artery bypass surgery. A systematic review and meta-analysis was carried out, involving a study of the past 10 years of the following databases: CINAHL, LILACS, MEDLINE, PsycINFO, SciELO, Scopus, and Web of Science. The total sample comprised n = 16,501 patients. The total number of items was n = 65, with n = 29 included in the meta-analysis. Based on the different measurement tools used, the prevalence of depression pre-CABG ranges from 19-37%, and post-CABG from 15-33%. There is a considerable presence of depression in this type of patient, but this varies according to the measurement tool used and the quality of the study. Systematically detecting depression prior to cardiac surgery could identify patients at potential risk.
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Affiliation(s)
- María Correa-Rodríguez
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria, IBS, 18012 Granada, Spain
| | - Moath Abu Ejheisheh
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Campus Universitario de Ceuta, C/Cortadura del Valle s/n, 51001 Ceuta, Spain
| | | | - Almudena Velando-Soriano
- University Hospital Virgen de las Nieves. Andalusian Health Service. Av. de las Fuerzas Armadas 2, 18014 Granada, Spain
| | | | - José Luis Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
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Bajaj N, Sharma A, Bajaj S, Pisharody R, Patrikar S. Depressive disorders in angiographic-proven coronary artery disease: A Cross Sectional Study. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Luzzi C, Salata K, Djaiani C, Gershinsky M, Rao V, Carroll J, Katznelson R. Selective serotonin re-uptake inhibitors: risk of blood product transfusion and inotrope requirements in patients undergoing cardiac surgery. J Thorac Dis 2019; 11:3496-3504. [PMID: 31559056 DOI: 10.21037/jtd.2019.07.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Patients undergoing cardiac surgery exhibit a high prevalence of concomitant depression. The first-line pharmacological treatment modality for depression includes selective serotonin re-uptake inhibitors (SSRIs). Despite their efficacy, SSRIs are not without their own side-effects. Methods We conducted a retrospective observational study to determine if preoperative SSRI therapy was associated with higher rates of perioperative blood product transfusion, and higher incidence of inotropic requirements in patients undergoing elective cardiac surgery. A total of 2,943 patients were included in the study. Patients undergoing emergency surgery or surgery without cardiopulmonary bypass (CPB) were excluded. Based on preoperative SSRI status patients were classed into either SSRI group (n=95), or non-SSRI group (n=2,848). Data was acquired from the Toronto Anesthesia Perioperative Outcomes Database. Results Baseline preoperative variables included age, sex, body surface area, smoking history, past medical history, preoperative medications, baseline hemoglobin, creatinine, and planned surgical procedures. Perioperative transfusion of blood products and inotropic utilization were collected. Univariate analysis showed that patients in SSRI group were more likely to be female, have history of congestive heart failure, preoperative anemia, and likelihood of having more complex surgery, received more inotropes and fresh frozen plasma, and were more likely to have chest reopening for bleeding. There was no difference in postoperative morbidity and mortality between the SSRI and non-SSRI groups. Separate statistical models were constructed to determine association between transfusion of red blood cells, fresh frozen plasma, platelets, composite inotrope use, and SSRI therapy. SSRI variable was not significant in any of the multivariate models, indicating the lack of evidence of association between the SSRIs and either blood product transfusion, or inotrope requirements. Significant predictors of blood product transfusion included smaller body surface area, female gender, older age, low baseline hemoglobin levels, elevated creatinine, increased CPB, presence of deep hypothermic circulatory arrest, complex cardiac surgery, history diabetes mellitus, and congestive heart failure. Predictors of inotrope use included older age, elevated creatinine, increased CPB time, history of diabetes mellitus, and congestive heart failure. Conclusions The current study suggests that modifying preoperative therapy pertinent to SSRI treatment in patients undergoing elective cardiac surgery is not warranted.
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Affiliation(s)
- Carla Luzzi
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Konrad Salata
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Carine Djaiani
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Maxim Gershinsky
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Jo Carroll
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada
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McCann M, Stamp N, Ngui A, Litton E. Cardiac Prehabilitation. J Cardiothorac Vasc Anesth 2019; 33:2255-2265. [DOI: 10.1053/j.jvca.2019.01.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 02/06/2023]
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11
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Rosenblum A, Landy DC, Perrone MA, Whyte N, Kang R. The Presence of a Psychiatric Condition is Associated With Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Matched Case-Controlled Study. J Arthroplasty 2019; 34:446-449. [PMID: 30503308 DOI: 10.1016/j.arth.2018.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/15/2018] [Accepted: 10/31/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We sought to examine the association between having a psychiatric condition and undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS A matched case-control study was performed to control for age and gender. All patients over 16 years of age with FAI treated with hip arthroscopy by a single surgeon were randomly matched to a patient of the same age and gender undergoing knee arthroscopy for any diagnosis other than infection by the same surgeon during the same period. Conditional logistic regression was used to compare the odds of having a psychiatric condition between groups. RESULTS Fifty-one matched pairs of patients undergoing hip and knee arthroscopy were identified. Each group contained 35 females (69%) and had a mean age of 33.6 years. Of the 51 hip arthroscopy cases, 23 (45.1%) had a psychiatric condition. Of the 51 knee arthroscopy controls, 11 (21.6%) had a psychiatric condition. Patients undergoing hip arthroscopy were statistically significantly more likely to have a psychiatric condition compared to patients undergoing knee arthroscopy with an odds ratio of 3.4 (95% confidence interval 1.3-9.2, P < .01). CONCLUSION There was a strong association between having a psychiatric condition and undergoing hip arthroscopy for FAI. More research should be done investigating psychiatric conditions among patients with FAI and whether this association can identify strategies to optimize patient outcomes.
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Affiliation(s)
- Anna Rosenblum
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - David C Landy
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Michael A Perrone
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Noelle Whyte
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - Richard Kang
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, IL
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Vashishta R, Kendale SM. Relationship Between Preoperative Antidepressant and Antianxiety Medications and Postoperative Hospital Length of Stay. Anesth Analg 2019; 128:248-255. [DOI: 10.1213/ane.0000000000003910] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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13
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Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients. Int J Behav Med 2019; 25:658-668. [PMID: 30105602 DOI: 10.1007/s12529-018-9738-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields. METHOD Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure. RESULTS Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS. CONCLUSION Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes. TRIAL REGISTRATION NCT01357694.
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Kalakoti P, Sciubba DM, Pugely AJ, McGirt MJ, Sharma K, Patra DP, Phan K, Madhavan K, Menger RP, Notarianni C, Guthikonda B, Nanda A, Sun H. Impact of Psychiatric Comorbidities on Short-Term Outcomes Following Intervention for Lumbar Degenerative Disc Disease. Spine (Phila Pa 1976) 2018; 43:1363-1371. [PMID: 29481379 DOI: 10.1097/brs.0000000000002616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, observational cohort study. OBJECTIVE To investigate the impact of psychiatric diseases on short-term outcomes in patients undergoing fusion surgery for lumbar degenerative disc disease (LDDD). SUMMARY OF BACKGROUND DATA Limited literature exists on the prevalence and impact of psychiatric comorbidities on outcomes in patients undergoing surgery for LDDD. METHODS Adult patients (>18 yr) registered in the Nationwide Inpatient Sample database (2002-2011) and undergoing an elective spine fusion for LDDD that met inclusion criteria formed the study population. Defined primary outcome measures were discharge disposition, length of stay, hospitalization cost, and short-term postsurgical complications (neurological, respiratory, cardiac, gastrointestinal, wound complication and infections, venous thromboembolism, and acute renal failure). Multivariable regression techniques were used to explore the association of psychiatric comorbidities on short-term outcomes by adjusting for patient demographics, clinical, and hospital characteristics. RESULTS Of the 126,044 adult patients undergoing fusion surgery for LDDD (mean age: 54.91 yr, 58% female) approximately 18% had a psychiatric disease. Multivariable regression analysis revealed patients with psychiatric disease undergoing fusion surgery have higher likelihood for unfavorable discharge (odds ratio [OR] 1.41; 95% confidence interval [CI] 1.35-1.47; P < 0.001), length of stay (OR 1.03; 95% CI 1.02-1.04; P < 0001), postsurgery neurologic complications (OR 1.25; 95% CI 1.13-1.37; P < 0.001), venous thromboembolic events (OR 1.38 95% CI 1.26-1.52; P < 0.001), and acute renal failure (OR 1.17; 95% CI 1.01-1.37; P = 0.040). Patients with psychiatric disease were also associated to have higher hospitalization cost (6.3% higher; 95% CI: 5.6%-7.1%; P < 0.001) compared to those without it. CONCLUSION Our study quantifies the estimates for presence of concomitant psychiatric comorbid conditions on short outcomes in patients undergoing fusions for LDDD. The data provide supporting evidence for adequate preoperative planning and postsurgical care including consultation for mental health for favorable outcomes. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Piyush Kalakoti
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew J Pugely
- Department of Spine Surgery, Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Kanika Sharma
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Devi P Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Karthik Madhavan
- Department of Neurosurgery, Miller School of Medicine, University of Miami, FL
| | - Richard P Menger
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Christina Notarianni
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
| | - Hai Sun
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA
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Outcomes after traumatic injury in patients with preexisting psychiatric illness. J Trauma Acute Care Surg 2017; 83:882-887. [PMID: 28538629 DOI: 10.1097/ta.0000000000001588] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with psychiatric illness have been shown to experience higher rates of traumatic injury. Injury patterns, treatment decisions, and outcomes have not been well characterized in patients with psychiatric illness after injury, in particular those who undergo acute surgical intervention. The purpose of this analysis was to determine mortality, complications, and surgical intervention rates in patients with psychiatric illness after traumatic injury. METHODS This is a retrospective study of trauma patients ≥18 years old admitted to LAC + USC Medical Center between January 2008 and March 2015. Patients with psychiatric diagnoses were identified using ICD-9 diagnosis codes. Multivariate logistic regression analyses taking into account demographic and injury characteristics were used to identify associations between psychiatric comorbidity, injury mechanism, surgical interventions, and outcomes in patients after injury. RESULTS A total of 26,502 patients were analyzed. Of these, 3,040 (11.5%) had a documented psychiatric comorbidity (2.0% depressive disorder, 0.8% bipolar disorder, 1.3% schizophrenia, 0.5% anxiety disorder, 3.2% substance use disorder). Patients with psychiatric illness were significantly older (49.6 years vs. 42.0 years, p < 0.001), had a lower proportion of penetrating injuries (13.8% vs. 18.1%, p < 0.001), and had a higher incidence of self-inflicted injuries (11.6% vs. 0.72%, p < 0.001). No difference in gender distribution was observed (74.2% men vs. 74.4% men, p = 0.80). Overall mortality was similar in both groups (adjusted odds ratio [aOR], 0.73; p = 0.07). Patients with psychiatric illness were significantly less likely to undergo acute surgical intervention within 6 hours of emergency department admission (aOR, 0.64; p < 0.001). Time from ED arrival to consent for acute surgical intervention was similar in both groups (94.8 min vs. 93.0 min, p = 0.84). No significant difference in mortality after acute surgical intervention was observed (aOR, 0.26; p = 0.10). Psychiatric illness was associated with a significantly higher likelihood of developing complications (aOR, 1.90; p < 0.001) and longer hospital lengths of stay (10.6 days vs. 6.2 days, p < 0.001). CONCLUSIONS Trauma patients with comorbid psychiatric illness were observed to have lower rates of acute surgical interventions, higher complication rates, and longer hospital lengths of stay. Further studies are needed to better characterize the causative factors underlying these associations. LEVEL OF EVIDENCE Epidemiological, level III.
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Flaherty LB, Wood T, Cheng A, Khan AR. Pre-existing psychological depression confers increased risk of adverse cardiovascular outcomes following cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2017; 154:1578-1586.e1. [DOI: 10.1016/j.jtcvs.2017.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/02/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Dedeogullari E, Paholpak P, Barkoh K, Lucas J, Lee L, Wang C, Hsieh PC, Wang JC, Buser Z. Effect of mental health on post -operative infection rates following cervical spine fusion procedures. J Orthop 2017; 14:501-506. [PMID: 28855766 DOI: 10.1016/j.jor.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether having an existing psychiatric disorder is a risk factor for developing post-operative infection following anterior cervical discectomy with fusion (ACDF) and posterior cervical fusion (PCF). RESULTS A total of 34,007 patients within Humana database was included in this study. Patients with mental disorders had post-operative infection rates of 3.2% and 4.4% within 1 and 3months, compared to 2.5% and 3.5% in patients without a psychiatric disorder (p < 0.05). CONCLUSIONS Patients with mental disorders had significantly higher rates of post-operative infection compared to patients who were never diagnosed with a psychiatric disorder.
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Affiliation(s)
- Emin Dedeogullari
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Permsak Paholpak
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kaku Barkoh
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joshua Lucas
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Larry Lee
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Association of Depression With 90-Day Hospital Readmission After Total Joint Arthroplasty. J Arthroplasty 2016; 31:2385-2388. [PMID: 27211986 DOI: 10.1016/j.arth.2016.04.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hospital readmission after total joint arthroplasty accounts for substantial resource consumption. Depression has been shown to impact postsurgical outcomes. We therefore aimed to study the association of depression with risk of readmission after total joint arthroplasty. METHODS Retrospective cohort data from the population-based California Healthcare Cost and Utilization Project database from 2007 to 2010 were analyzed using multivariable logistic regression to predict odds of 90-day readmission after hospital discharge for primary total knee arthroplasty (TKA, n = 132,422) or total hip arthroplasty (THA, n = 65,071) arthroplasty in adults ages 50+ years. We included the primary exposure of depression and controlled for age, sex, race/ethnicity, Medicaid insurance, comorbidities, and admission year. RESULTS Overall 90-day readmission rates were approximately 8% for TKA and THA. Even after controlling for other chronic conditions and nonmodifiable covariates, we found depression predicted higher likelihood of readmission. The odds of readmission for subjects with depression were 21%-24% higher overall (odds ratio for TKA: 1.21, 95% confidence interval: 1.13-1.29; odds ratio for THR: 1.24, 95% confidence interval: 1.13-1.35; P < .001). Subjects with surgery in earlier years were also more likely to be readmitted (P < .01). CONCLUSION Depression is associated with a significantly higher risk of readmission after THA and TKA. Hospital readmissions must be minimized to improve care quality, while making these procedures fiscally feasible. Promoting care coordination across disciplines for management of nonorthopedic comorbidities before surgery, particularly in higher risk patients with depression, could optimize orthopedic surgery outcomes, patient well-being, and costs of care. Therefore, every effort to address depression before surgery is warranted.
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Klement MR, Nickel BT, Penrose CT, Bala A, Green CL, Wellman SS, Bolognesi MP, Seyler TM. Psychiatric disorders increase complication rate after primary total knee arthroplasty. Knee 2016; 23:883-6. [PMID: 27288068 DOI: 10.1016/j.knee.2016.05.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Psychiatric disease is difficult to screen preoperatively and the incidence of mental health disorders in patients undergoing total knee arthroplasty (TKA) may be underappreciated. The purpose of this study is to evaluate the perioperative complication profile in patients with psychiatric disorders. METHODS A search of the entire Medicare database from 2005 to 2011 was performed to identify patients who underwent primary TKA with bipolar disorder (20,972), depression (187,448), and schizophrenia (7607). A cohort of 1,271,464 patients as controls with minimum 2.5-year follow-up. Medial and surgical complications at 30-days, 90-days, and overall were compared between the two cohorts. RESULTS Patients with any psychiatric disease were more likely to be younger (age<65 OR 5.5, p<0.001), female (OR 2.61, p<0.001), and more medically complex (significant increase in 28/28 Elixhauser medical comorbidities, p<0.05). There was a significant increase (p<0.001) in 11/14 (78.5%) of recorded postoperative medical complication rates at 90-days. There was a statistically significant increase in periprosthetic infection (OR 2.17 p<0.001), periprosthetic fracture (OR 2.40, p<0.001), revision TKA (OR 2.06, p<0.001), and extensor mechanism rupture (OR 2.41, p<0.001) at 90day and overall time points. CONCLUSIONS Patients with psychiatric disorders who undergo elective primary TKA have significantly increased medical and surgical complication rates in the global period and short term follow-up. An ideal screening tool is yet to be determined and these patients need to be counseled appropriately regarding the increased complication rates before proceeding with TKA.
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Affiliation(s)
- Mitchell R Klement
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States.
| | - Brian T Nickel
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
| | - Colin T Penrose
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
| | - Abiram Bala
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University, 7062 North Pavilion, DCRI, Durham, NC 27705, United States
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710, United States
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Klement MR, Bala A, Blizzard DJ, Wellman SS, Bolognesi MP, Seyler TM. Should We Think Twice About Psychiatric Disease in Total Hip Arthroplasty? J Arthroplasty 2016; 31:221-6. [PMID: 27067760 DOI: 10.1016/j.arth.2016.01.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/23/2016] [Accepted: 01/26/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Psychiatric disease (PD) is common, and the effect on complications in total hip arthroplasty (THA) is poorly understood. The purpose of this study was to evaluate the medical and surgical postoperative complication profile in patients with PD, and we hypothesize that they will be significantly increased compared with control group. METHODS A search of the entire Medicare database from 2005 to 2011 was performed using International Classification of Disease version 9 codes to identify 86,976 patients who underwent primary THA with PD including bipolar (5626), depression (82,557), and schizophrenia (3776). A cohort of 590,689 served as a control with minimum 2-year follow-up. Medical and surgical complications at 30-day, 90-day, and overall time points were compared between the 2 cohorts. RESULTS Patients with PD were more likely to be younger (age < 65 years; odds ratio [OR] = 4.51, P < .001), female (OR = 2.02, P < .001) and more medically complex (significant increase in 28/28 Elixhauser medical comorbidities, P < .001). There was a significant increase (P < .001) in 13/14 (92.8%) recorded postoperative medical complications rates at the 90-day time point. In addition, there was a statistically significant increase in periprosthetic infection (OR = 2.26, P < .001), periprosthetic fracture (OR = 2.09, P < .001), dislocation (OR = 2.30, P < .001), and THA revision (OR = 1.93, P < .001) at overall follow-up. CONCLUSION Patients with PD who undergo elective primary THA have significantly increased medical and surgical complication rates in the global period and short-term follow-up, and these patients need to be counseled accordingly.
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Affiliation(s)
- Mitchell R Klement
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Abiram Bala
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Blizzard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Stenman M, Holzmann MJ, Sartipy U. Association between preoperative depression and long-term survival following coronary artery bypass surgery - A systematic review and meta-analysis. Int J Cardiol 2016; 222:462-466. [PMID: 27505334 DOI: 10.1016/j.ijcard.2016.07.216] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression is common in patients with cardiovascular disease. The importance of preoperative depression for long-term survival following coronary artery bypass grafting (CABG) is not well known. The aim was to provide a summary estimate of the association between preoperative depression and long-term survival in adults who underwent CABG. METHODS We did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, and PubMed from inception to November, 2015, including cohort studies with at least one month of follow-up that reported hazard ratios (HR) and 95% confidence intervals (CI) for long-term all-cause mortality following CABG in patients with preoperative depression compared to non-depressed patients. Two reviewers independently extracted data on populations, exposure, outcome, risk of bias, and quality of evidence. We calculated HR and 95% CIs for all-cause mortality using random-effects meta-analyses and performed subgroup and sensitivity analyses. RESULTS Seven studies were included with a combined study population of 89,490 patients (4002 depressed/85,488 non-depressed). All studies observed a positive association between preoperative depression and all-cause mortality, and in 4 studies the association was statistically significant. Patients with depression had a pooled hazard ratio of 1.46 (95% CI: 1.23-1.73, p<0.0001) for all-cause mortality with moderate heterogeneity (I(2)=50.1%, p=0.061). CONCLUSIONS This systematic review and meta-analysis indicates that patients with preoperative depression are at increased risk for long-term, all-cause mortality following CABG compared with those without depression. Systematic screening for depression prior to cardiac surgery could identify those at higher risk.
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Affiliation(s)
- Malin Stenman
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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The Influence of Psychiatric Comorbidity on Inpatient Outcomes following Distal Humerus Fractures. ACTA ACUST UNITED AC 2016. [DOI: 10.1155/2016/4913808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. The influence of psychiatric comorbidity on outcomes following inpatient management of upper extremity fractures is poorly understood. Methods. The National Hospital Discharge Survey was queried to identify patients admitted to US hospitals with distal humerus fractures between 1990 and 2007. Patients were subdivided into 5 groups: depression, anxiety, schizophrenia, dementia, and no psychiatric comorbidity. Multivariable logistic regression analysis identified independent risk factors for adverse events, requirement of blood transfusion, and discharge to another inpatient facility. Results. A cohort representative of 526,185 patients was identified as having a distal humerus fracture. Depression, anxiety, and dementia were independently associated with higher odds of in-hospital adverse events (P<0.001). Depression was associated with higher odds of inpatient blood transfusion (P<0.001). Depression, schizophrenia, and dementia were associated with higher odds of nonroutine discharge to another inpatient facility (P<0.001). Patients with a diagnosis of schizophrenia had a mean of 12 (P<0.001) more days of care than patients with no psychiatric comorbidity. Discussion. Patients with comorbid psychiatric illness who are admitted to hospitals with distal humerus fractures are at increased risk of inpatient adverse events and posthospitalization care.
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Kazmierski J, Banys A, Latek J, Bourke J, Jaszewski R, Sobow T, Kloszewska I. Mild cognitive impairment with associated inflammatory and cortisol alterations as independent risk factor for postoperative delirium. Dement Geriatr Cogn Disord 2015; 38:65-78. [PMID: 24603477 DOI: 10.1159/000357454] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 12/14/2022] Open
Abstract
AIMS The present study aimed to determine the impact of mild cognitive impairment (MCI) on the development of postoperative delirium and, secondly, to assess the association between MCI and raised perioperative cortisol, cytokine, cobalamin and homocysteine levels. METHODS The study recruited 113 consecutive adult patients scheduled for cardiac surgery with cardiopulmonary bypass. The patients were examined preoperatively with the Montreal Cognitive Assessment and Trail Making Test. A diagnosis of MCI was established based upon the criteria of the National Institute on Aging and Alzheimer's Association. Patients were screened for delirium within the first 5 days postoperatively. RESULTS MCI was diagnosed in 24.8% of the patients, whereas the frequency of delirium was 36%. A multivariate analysis demonstrated that individuals with MCI were at a significantly higher risk of postoperative delirium (OR = 6.33, p = 0.002). Preoperative cortisol, postoperative cortisol and IL-2 plasma levels were higher in the MCI group as compared to non-MCI subjects. CONCLUSION MCI is associated with a higher risk of postoperative delirium. Perioperative cortisol and inflammatory alterations observed in MCI may provide a physiological explanation for this increased risk.
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Affiliation(s)
- Jakub Kazmierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Abstract
OBJECTIVE Mortality on medical intensive care units (ICU) is approximately 25%. It is associated with age, severity of illness, and comorbidities. Preexisting depression is a risk factor for worse outcome in many diseases. The impact of depression on outcome of ICU patients has not been investigated. We assessed a possible association between mortality and preexisting depressive mood at the time of ICU admission. The primary end point was 28-day mortality. METHODS This single-center cohort study was conducted in a tertiary medical ICU. Two hundred patients were evaluated for preexisting depressive mood at ICU admission, determined by Hospital Anxiety and Depression Scale (HADS) score ≥8 in the depression dimension in patients with appropriate cognitive function. Patients with insufficient cognitive function were assessed using observer rating by next of kin by Hammond scale (cutoff ≥4) and/or a modified version of the Hospital Anxiety and Depression Scale for observer rating (cutoff ≥10). RESULTS In total, 66 (33%) of 200 patients were classified with preexisting depressive mood. Forty-nine (24.5%) of 200 patients had died by day 28. Of these, 23 (47%) had preexisting depressive mood as compared with 43 of 151 (29%) 28-day survivors (p = .017). Multiple logistic regression analysis revealed that preexisting depressive mood at the time of ICU admission is an independent risk factor for 28-day (odds ratio = 2.2, 95% confidence interval = 1.08-4.5, p = .030) and in-hospital mortality (median time till death = 20.5 [2-186] days, odds ratio = 2.58, 95% confidence interval = 1.31-5.1, p = .006). CONCLUSION Preexisting depressive mood might be an independent risk factor for 28-day mortality in medical ICU patients. This could have diagnostic and therapeutic implications for critically ill patients.
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The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database. J Arthroplasty 2015; 30:165-70. [PMID: 25267536 DOI: 10.1016/j.arth.2014.08.034] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 08/26/2014] [Accepted: 08/30/2014] [Indexed: 02/01/2023] Open
Abstract
Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P<0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P<0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P<0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P<0.001).
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Stenman M, Holzmann MJ, Sartipy U. Relation of major depression to survival after coronary artery bypass grafting. Am J Cardiol 2014; 114:698-703. [PMID: 25027773 DOI: 10.1016/j.amjcard.2014.05.058] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 02/02/2023]
Abstract
The primary aim was to study the association between preoperative depression and long-term survival after coronary artery bypass grafting (CABG). Our secondary objective was to analyze the association between depression and cardiovascular events or all-cause mortality. In a nationwide, population-based, cohort study, all patients who underwent CABG in Sweden from 1997 to 2008 were included from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry. Individual-level data were cross-linked from other national Swedish registers. Depression status and outcomes were obtained from the National Patient Register. The study population was 56,064 patients who underwent primary, isolated, nonemergent CABG. We identified 324 patients (0.6%) with depression before CABG. During a mean follow-up of 7.5 years, 114 patients (35%) with depression died, compared with 13,767 patients (25%) in the control group. Depression was significantly associated with increased mortality and the combined end point of death or rehospitalization for myocardial infarction, heart failure, or stroke (multivariate-adjusted hazard ratios [95% confidence intervals] 1.65 [1.37 to 1.99] and 1.61 [1.38 to 1.89], respectively). In conclusion, we found a strong and significant association between depression and long-term survival in patients with established ischemic heart disease who underwent CABG. Depression was also associated with an increased risk for a combination of death or rehospitalization for heart failure, myocardial infarction, or stroke.
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Bot AGJ, Menendez ME, Neuhaus V, Ring D. The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:519-27. [PMID: 24630546 DOI: 10.1016/j.jse.2013.12.006] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 11/25/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Psychiatric comorbidity has been associated with increased health risks and poor long-term treatment outcomes in numerous medical disciplines, but its effect in short-term perioperative settings is incompletely understood. The purpose of this study was to evaluate the influence of a preoperative diagnosis of depressive disorder, anxiety disorder, schizophrenia, or dementia on in-hospital (1) adverse events, (2) blood transfusion, and (3) nonroutine discharge in patients undergoing shoulder arthroplasty. METHODS Using the National Hospital Discharge Survey (NHDS) database, we identified 348,824 discharges having undergone partial or total shoulder arthroplasty from 1990 to 2007. Multivariable regression analysis was performed for each of the outcome variables. RESULTS The prevalence of diagnosed depressive disorder was 4.4%, anxiety disorder, 1.6%; schizophrenia, 0.6%; and dementia, 1.5%. Preoperative psychiatric disorders, with the exception of schizophrenia, were associated with higher rates of adverse events. Depression and schizophrenia were associated with higher perioperative rates of blood transfusion. Any preoperative psychiatric illness was associated with higher rates of nonroutine discharge. CONCLUSIONS Patients with preoperative psychiatric illness undergoing shoulder arthroplasty are at increased risk for perioperative morbidity and posthospitalization care. Preoperative screening of psychiatric illness might help with planning of shoulder arthroplasty.
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Affiliation(s)
- Arjan G J Bot
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Mariano E Menendez
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - Valentin Neuhaus
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
STUDY DESIGN Analysis of the National Hospital Discharge Survey database from 1990 to 2007. OBJECTIVE To evaluate the influence of preoperative depression, anxiety, schizophrenia, or dementia on in-hospital (1) adverse events, (2) mortality, and (3) nonroutine discharge in patients undergoing major spine surgery. SUMMARY OF BACKGROUND DATA Psychiatric comorbidity is a known risk factor for impaired health-related quality of life and poor long-term outcomes after spine surgery, yet little is known about its impact in the perioperative spine surgery setting. METHODS Using the National Hospital Discharge Survey database, all patients undergoing either spinal fusion or laminectomy between 1990 and 2007 were identified and separated into groups with and without psychiatric disorders. Multivariable regression analysis was performed for each of the outcome variables. RESULTS Between 1990 and 2007, a total estimated number of 5,382,343 spinal fusions and laminectomies were performed. The prevalence of diagnosed depression, anxiety, and schizophrenia among the study population increased significantly over time. Depression, anxiety, schizophrenia, and dementia were associated with higher rates of nonroutine discharge. Depression, schizophrenia, and dementia were associated with higher rates of adverse events. Dementia was the only psychiatric disorder associated with a higher risk of in-hospital mortality. CONCLUSION Patients with preoperative psychiatric disorders undergoing major spine surgery are at increased risk for perioperative adverse events and posthospitalization care, but its effect in perioperative mortality is more limited. Presurgical psychological screening of candidates undergoing spine surgery might ultimately lead to the enhancement of perioperative outcomes in this growing segment of the US population. LEVEL OF EVIDENCE N/A.
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Meyer T, Belnap BH, Herrmann-Lingen C, He F, Mazumdar S, Rollman BL. Benefits of collaborative care for post-CABG depression are not related to adjustments in antidepressant pharmacotherapy. J Psychosom Res 2014; 76:28-33. [PMID: 24360138 DOI: 10.1016/j.jpsychores.2013.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/25/2013] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether the use and adjustment of antidepressant pharmacotherapy accounted for the beneficial effects of collaborative care treatment on the improvement of mood symptoms and health-related quality of life (HRQoL) after coronary artery bypass graft (CABG) surgery. METHODS In a post-hoc analysis of data from the Bypassing the Blues (BtB) trial we tested the impact of antidepressant medication on changes in depression and HRQoL from the early postoperative period to 8-month follow-up. Two hundred fifty-nine depressed post-CABG patients scoring ≥10 on the Patient Health Questionnaire-9 were classified in four groups according to whether or not they received antidepressants at baseline and 8-months following randomization. RESULTS Patients using antidepressant pharmacotherapy at baseline and follow-up tended to be younger and female (p≤0.01), but were similar in various clinical characteristics. Just 24% (63/259) of patients were on an antidepressant at baseline which increased to 36% at follow-up (94/259). Compared to other groups, patients on antidepressants at both baseline and follow-up assessment showed the smallest improvement in mood symptoms and HRQoL. While multivariate analyses confirmed that randomization to collaborative care was associated with greater improvement in mood symptoms (odds ratio [OR]=3.1; 95%-confidence interval [CI]=1.8-5.4, p<0.0001) and mental HRQoL (OR=3.6, CI=1.4-9.3, p=0.01), use of antidepressant medication had no differential impact on either measure (p=0.06 and p=0.92, respectively). CONCLUSION The beneficial effects of collaborative care for post-CABG depression were not generated by adjustments in antidepressant medication. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00091962. (http://clinicaltrials.gov/ct2/show/NCT00091962?term=rollman+cabg&rank=1).
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Affiliation(s)
- Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Bea Herbeck Belnap
- Disivion of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Fanyin He
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sati Mazumdar
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce L Rollman
- Disivion of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Untreated preoperative depression is not associated with postoperative arrhythmias in CABG patients. Can J Anaesth 2013; 61:12-8. [PMID: 24218191 DOI: 10.1007/s12630-013-0051-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The mechanism by which depression affects postoperative outcome may involve arrhythmias. The purpose of this study was to evaluate whether untreated depression is associated with an increased incidence of postoperative arrhythmias in patients undergoing coronary artery bypass graft surgery (CABG). METHODS One hundred seven patients were assessed for signs of depression with the Prime-MD Patient Health Questionnaire (brief PHQ) one week before surgery and subsequently underwent Holter monitoring for 48-72 hr postoperatively. The incidences of atrial fibrillation (AF); supraventricular tachycardia (SVT); ventricular tachycardia (VT), defined as three or more consecutive beats at a cycle length less than 600 msec; ventricular fibrillation (VF); and average heart rate (HR) were recorded in patients with and without signs of depression. RESULTS The incidence of preoperative untreated depression was 27% (29/107). Twenty patients had mild depression (brief PHQ score of 5-9), seven patients had moderate depression (a score of 10-14), and two patients had severe depression (a score of 20). The incidences of postoperative AF, SVT, and non-sustained VT in depressed and non-depressed patients were 37.9% vs 35.9%, respectively (P = 0.50), 34.4% vs 52.5%, respectively (P = 0.07), and 17.2% vs 37.1%, respectively (P = 0.04). The average (SD) postoperative HR was similar in both groups [95 (12) beats·min(-1) in depressed patients and 92 (10) beats·min(-1) in non-depressed patients, (P = 0.25)]. Multivariate regression analysis showed that older age, but not depression, was a risk factor for postoperative arrhythmia. CONCLUSIONS Preoperative untreated depression is not related to postoperative arrhythmia in the early postoperative period in patients undergoing elective CABG. This trial was registered at clinicaltrials.gov (number: NCT00622024).
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Rude J, Azimova K, Dominguez C, Sarosiek J, Edlavitch S, Mukherjee D. Depression as a Predictor of Length of Stay in Patients Admitted to the Cardiovascular Intensive Care Unit at a University Medical Center. Angiology 2013; 65:580-4. [DOI: 10.1177/0003319713496868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depression is a predictor of length of stay (LOS) and adverse outcomes in patients with cardiac disease. Our objective was to assess the impact of depression on LOS in a Hispanic population admitted to a cardiovascular intensive care unit (CVICU). This was a prospective study of 151 consecutive patients admitted to the CVICU. Patients were administered the Center for Epidemiologic Studies Depression (CES-D) scale survey within 24 hours of admission. Patients were followed until discharge to determine LOS and adverse outcomes. Depression was more prevalent in Hispanic patients than in nonHispanic patients based on the CES-D scores (41% vs 14%). Using multivariate analysis, the presence of depression was a significant predictor of increased LOS ( P = .001). Depression has a significant impact on LOS in a Hispanic population. Appropriate treatment of depression may decrease LOS and has the potential to be cost effective in the current health care environment.
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Affiliation(s)
| | | | | | | | - Stanley Edlavitch
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol 2013; 2013:695925. [PMID: 23653854 PMCID: PMC3638710 DOI: 10.1155/2013/695925] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/18/2013] [Indexed: 12/13/2022] Open
Abstract
In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
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Kazmierski J, Banys A, Latek J, Bourke J, Jaszewski R. Cortisol levels and neuropsychiatric diagnosis as markers of postoperative delirium: a prospective cohort study. Crit Care 2013; 17:R38. [PMID: 23452669 PMCID: PMC3733427 DOI: 10.1186/cc12548] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 02/25/2013] [Indexed: 11/30/2022] Open
Abstract
Introduction The pathophysiology of delirium after cardiac surgery is largely unknown. The
purpose of this study was to investigate whether increased concentration of
preoperative and postoperative plasma cortisol predicts the development of
delirium after coronary artery bypass graft surgery. A second aim was to assess
whether the association between cortisol and delirium is stress related or
mediated by other pathologies, such as major depressive disorder (MDD) or
cognitive impairment. Methods The patients were examined 1 day preoperatively with the Mini International
Neuropsychiatric Interview and the Montreal Cognitive Assessment and the Trail
Making Test to screen for depression and for cognitive impairment, respectively.
Blood samples for cortisol levels were collected both preoperatively and
postoperatively. The Confusion Assessment Method for the Intensive Care Unit was
used within the first 5 days postoperatively to screen for a diagnosis of
delirium. Results Postoperative delirium developed in 36% (41 of 113) of participants. Multivariate
logistic regression analysis revealed two groups independently associated with an
increased risk of developing delirium: those with preoperatively raised cortisol
levels; and those with a preoperative diagnosis of MDD associated with raised
levels of cortisol postoperatively. According to receiver operating characteristic
analysis, the most optimal cutoff values of the preoperative and postoperative
cortisol concentration that predict the development of delirium were 353.55 nmol/l
and 994.10 nmol/l, respectively. Conclusion Raised perioperative plasma cortisol concentrations are associated with delirium
after coronary artery bypass graft surgery. This may be an important
pathophysiological consideration in the increased risk of postoperative delirium
seen in patients with a preoperative diagnosis of MDD.
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Postoperative Anxiety and Depression in Patients Undergoing Thoracoscopic Closure of Congenital Heart Defects. J Cardiovasc Nurs 2012; 27:547-52. [DOI: 10.1097/jcn.0b013e31822d0c39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Depression is associated with prolonged and complicated recovery following colorectal surgery. J Gastrointest Surg 2011; 15:1712-7. [PMID: 21786060 DOI: 10.1007/s11605-011-1640-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are little data regarding the impact of depression on outcomes after gastrointestinal surgery. We hypothesize that depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery. METHODS We identified 292,191 patients undergoing colon and rectal surgery using the 2008 Nationwide Inpatient Sample. We used multivariate regression to evaluate the effect of depression on length of stay and discharge disposition. RESULTS A preoperative diagnosis of depression was present in 20,039 (6.9%) patients. Mean length of stay for those with depression (10.4 days, 95% confidence interval (CI) 10.04-10.76) was significantly longer than for patients without depression (9.64 days, 95% CI 9.48-9.81). After adjusting for cofounders, depression still predicted an increase in length of stay. Additionally, depressed patients were less likely to resume normal function at discharge, as 40% required either home health or time in a skilled facility following discharge from the acute care hospital. CONCLUSIONS Among patients undergoing colorectal surgery, depression is associated with a significantly prolonged hospital stay and higher likelihood of requiring skilled nursing assistance after discharge. Further research into the mechanism underlying these differences and potential treatment strategies among depressed patients is warranted.
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