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Published on: March 27, 2018
Presurgical depression predicts medical morbidity 6 months after coronary artery bypass graft surgery
Matthew M Burg1, M Cristina Benedetto, Roberta Rosenberg
1VA Connecticut Healthcare System, West Haven Campus, West Haven, CT 06516, USA. mburg@attglobal.net
Insights
Presurgical depression independently predicts worse outcomes after coronary artery bypass graft (CABG) surgery. This includes increased cardiac hospitalizations, persistent pain, and reduced activity levels six months post-surgery.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Depression is linked to poorer prognosis in coronary artery disease.
- Quality of life can be diminished after coronary artery bypass graft (CABG) surgery.
- The specific impact of presurgical depression on CABG outcomes requires further investigation.
Purpose of the Study:
- To determine the independent contribution of presurgical depression to short-term medical outcomes following CABG.
- To assess the relationship between depression and post-CABG recovery.
Main Methods:
- 89 male veterans undergoing CABG were assessed for medical, surgical, and psychosocial risk factors.
- The Beck Depression Inventory was administered pre-surgery.
- Outcomes including medical events, pain, and activity levels were evaluated at 6-month follow-up via interviews and medical record review.
Main Results:
- Presurgical depression independently predicted cardiac hospitalizations at 6 months (p <.04).
- Depression also predicted continued surgical pain (p <.01) and failure to return to previous activity levels (p <.0001) at 6 months.
- Presurgical depression was also associated with increased depressed affect at 6 months (p <.0003).
Conclusions:
- Presurgical depression is a significant independent predictor of medical and psychosocial morbidity up to 6 months post-CABG.
- These findings highlight the importance of addressing depression in patients undergoing CABG.
- Further research with larger, diverse populations is recommended to validate these results.
Objective:
Depression has been related to poor medical prognosis in patients with coronary artery disease and to diminished quality of life after coronary artery bypass graft surgery (CABG). However, prior studies have not fully examined the impact of depression on medical outcomes after CABG. The purpose of this study was to determine the independent contribution of presurgical depression to short-term medical outcome after CABG.
Methods:
Medical, surgical, and psychosocial risk factors were assessed before surgery in 89 male veterans undergoing CABG. In addition, patients completed the Beck Depression Inventory. Medical, surgical, and psychological/quality-of-life outcomes were determined at 6 months of follow-up by telephone interview and review of medical records.
Results:
Of the 89 patients studied, 25 scored 10 or greater on the Beck Depression Inventory. The study population was dichotomized on the basis of this cutoff point. A medical prediction model was developed for each outcome of interest, based on the range of medical, surgical, and psychosocial risk indices assessed. The dichotomized depression index was added to these prediction models as a final step. This depression index was found to independently predict cardiac hospitalizations at 6 months (chi(2) = 4.24, p <.04), continued surgical pain at 6 months (chi(2) = 6.36, p <.01), and failure to return to previous activity at 6 months (chi(2) = 15.04, p <.0001). Presurgical depression also predicted depressed affect at 6 months (chi(2) = 13.16, p <.0003).
Conclusions:
Depression is an important independent contributor to medical and psychosocial morbidity up to 6 months after CABG. These findings warrant replication with larger and more diverse populations.
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