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Preoperative depression and mortality in coronary artery bypass surgery: preliminary findings
R A Baker1, M J Andrew, G Schrader
1Cardiac Surgical Research Unit, Flinders Medical Centre, Queen Elizabeth Hospital, Adelaide, South Australia. Rob.Baker@flinders.edu.au
Insights
Elevated depressive symptoms before coronary artery bypass surgery significantly increased the risk of late mortality. This finding highlights the importance of assessing depression in cardiac surgery patients for improved long-term outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Health Outcomes Research
Background:
- Depression is a known risk factor for mortality after myocardial infarction.
- Limited data exist on depression as a risk factor for mortality post-cardiac surgery.
Purpose of the Study:
- To investigate if preoperative depressive symptoms predict late mortality after coronary artery bypass surgery.
Main Methods:
- 158 patients undergoing coronary artery bypass surgery were assessed for preoperative depressive symptoms using the Depression Anxiety Stress Scale (DASS).
- Elevated symptoms were defined as a DASS score >= 10.
Main Results:
- 15.2% of patients had elevated preoperative depressive symptoms.
- Patients with elevated symptoms had a significantly higher mortality rate (12.5%) compared to non-depressed patients (2.2%) over a median 25-month follow-up (OR: 6.24, P=0.046).
- No significant differences were found in demographics, medical risk factors, surgical parameters, or postoperative morbidity between groups.
Conclusions:
- Preoperative depressive symptoms may be a significant predictor of late mortality in patients undergoing coronary bypass surgery.
- Further prospective studies are needed to confirm the prevalence and impact of depressive symptoms on long-term outcomes in cardiac surgical patients.
Background:
There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery.
Methods:
Preoperative assessments of depressive symptoms were performed on 158 patients undergoing coronary artery bypass surgery. Elevated preoperative depression symptoms were defined as a depression anxiety stress scale score of > or = 10.
Results:
Twenty-four of the 158 patients ( 15.2%) were classified as having elevated preoperative depressive symptoms. Patients were followed for a median of 25 months (range: 4-38 months). Three of the 24 patients (12.5%) with preoperative depressive symptoms died within the follow-up period, compared with three of the 134 (2.2%) non-depressed patients (odds ratio: 6.24; 95% CI: 1.18-32.98; P = 0.046). There were no other group differences on variables including population demographics, medical risk factors, surgical parameters, and indices of postoperative morbidity.
Conclusions:
Elevated depressive symptoms before coronary bypass surgery may be a significant predictor of late death. Prospective studies evaluating the prevalence of depressive symptoms in cardiac surgical patients and their effect on long-term outcome must be undertaken.