Comorbid depression is associated with non-routine discharge following treatment of unruptured cerebral aneurysms

Psychiatric comorbidities such as depression have previously been associated with adverse outcomes after neurosurgical interventions. Non-routine discharge, defined as discharge to any location other than the patient's home, has subsequently been associated with an increased likelihood of adverse post-discharge outcomes, readmission, and negative impacts on quality of life. To date, no prior studies have evaluated the association between depression, other psychiatric comorbidities, and clinical outcomes following surgical management of unruptured cerebral aneurysms (UCAs).

We conducted a retrospective analysis of the Nationwide Readmissions Database (NRD, 2016-2020). ICD-10-CM/PCS codes were used to select for patients who had (1) an unruptured aneurysm and (2) underwent open/endovascular treatment of their aneurysm. Patients with documented subarachnoid hemorrhage were excluded. Multivariable regression analyses were conducted to evaluate the association between comorbid depression and other psychiatric disease diagnoses (anxiety, schizophrenia, bipolar disorder, PTSD, etc.) with discharge disposition, length of stay (LOS), mortality, major complications, and 30-/90-day non-elective readmissions.

From 2016 to 2020, 36,739 patients underwent repair (open or endovascular) of an UCA, and 15.4 % had a comorbid diagnosis of depression. Patients with depression were significantly more likely to have other psychiatric comorbidities such as anxiety (10.5 % vs 7.9 %, p < 0.001), identify as female (83.2 % vs 73.1 %, p < 0.001), and have an Elixhauser Comorbidity Index score of at least three (66.5 % vs 27.9 %, p < 0.001). After adjusting for covariates, both depression (RR 1.08, 95 % CI 1.02-1.14, p = 0.007) and other psychiatric comorbidities (RR 1.21, 95 % CI 1.14-1.29, p < 0.001) were associated with a higher likelihood of non-routine discharge. Depression was not associated with an increase in LOS or readmission rates; however, other psychiatric comorbidities were significantly associated with increases in both LOS (IRR 1.16, 95 % CI 1.09-1.24, p < 0.001) and 90-day readmission rates (OR 1.20, 95 % CI 1.05-1.38, p = 0.007).

In patients undergoing surgical intervention for UCAs, comorbid depression and other psychiatric diagnoses are associated with higher likelihood of adverse discharge dispositions. This should be further queried to identify underlying, modifiable targets of intervention that may improve patient outcomes and lower overall cost of care.