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Published on: March 27, 2018
Depression Is Associated With Non-Home Discharge After Coronary Artery Bypass Graft
Ryan M Holcomb1, Ahsan Zil-E-Ali2, Robert Gonzalez3
1Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Insights
Depression significantly increases the risk of non-home discharge after coronary artery bypass graft (CABG) surgery. This finding highlights the need for better preoperative screening of depression in cardiac patients.
Area of Science:
- Cardiology
- Psychiatry
- Health Services Research
Background:
- Depression is prevalent in patients with coronary artery disease (CAD).
- Depression is linked to adverse outcomes after cardiac procedures.
- Non-home discharge (NHD) is a critical quality metric following major surgery.
Purpose of the Study:
- To investigate the association between depression and NHD after coronary artery bypass graft (CABG) surgery.
- To determine if depression independently predicts NHD in CABG patients.
Main Methods:
- Analysis of the 2018 National Inpatient Sample database for CABG cases.
- Utilized ICD-10 codes to identify patients with and without depression.
- Employed multivariable logistic regression to control for confounders and assess the association between depression and NHD, and prolonged length of stay (LOS).
Main Results:
- 8.8% of 31,309 CABG patients had a history of depression.
- Depressed patients had significantly higher rates of NHD (70% increased odds) and prolonged LOS (24% increased odds) after adjustment.
- Depressed patients were younger, more often female, from lower income quartiles, and had greater medical complexity.
Conclusions:
- A history of depression is independently associated with a higher likelihood of non-home discharge following CABG.
- This study is the first to demonstrate this association in a national sample.
- Improved preoperative identification of depression is crucial for risk stratification and optimizing discharge planning for CABG patients.
Introduction:
Depression is disproportionately high in patients with coronary artery disease and has been associated with adverse outcomes following coronary artery bypass graft (CABG). One quality metric, non-home discharge (NHD), can have substantial implications for patients and health care resource utilization. Depression increases the risk of NHD after many operations, but it has not been studied after CABG. We hypothesized that a history of depression would be associated with an increased risk of NHD following CABG.
Methods:
CABG cases were identified from the 2018 National Inpatient Sample using ICD-10 codes. Depression, demographic data, comorbidities, length of stay (LOS), rate of NHD were analyzed using appropriate statistical tests where a P-value < 0.05 was defined as statistically significant. Adjusted multivariable logistic regression models were used to assess independent association between depression and NHD as well as LOS while controlling for confounders.
Results:
There were 31,309 patients, of which 2743 (8.8%) had depression. Depressed patients were younger, females, in a lower income quartile, and more medically complex. They also demonstrated more frequent NHD and prolonged LOS. After adjusted multivariable analysis, depressed patients had a 70% increased odds of NHD (adjusted odds ratio: 1.70 [1.52-1.89] P < 0.001) and a 24% increased odds of prolonged LOS (AOR: 1.24 [1.12-1.38] P < 0.001).
Conclusions:
From a national sample, depressed patients were associated with more frequent NHD following CABG. To our knowledge, this is the first study to demonstrate this, and it highlights the need for improved preoperative identification in order to improve risk stratification and timely allocation of discharge services.
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