In-Hospital Cardiac Surgery Outcomes Among Adults Hospitalized with Comorbid Depression
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP026
Submission Type:
Abstract Submission
Authors:
Ahmed Alnajar (1), Kelley Benck (2), Tawseef Dar (2), Sameer Hirji (3), Brian Detweiler (2), Joseph Lamelas (4)
Institutions:
(1) University of Miami Hospital, Miami, Florida, (2) University of Miami, Miami, FL, (3) Brigham and Women's Hospital, Allston, MA, (4) University of Miami Hospital, Miami, FL
Submitting Author:
Ahmed Alnajar
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University of Miami Hospital
University of Miami Hospital
Co-Author(s):
Kelley Benck
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University of Miami
University of Miami
Tawseef Dar
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University of Miami
University of Miami
Sameer Hirji
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Brigham and Women's Hospital
Brigham and Women's Hospital
Brian Detweiler
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University of Miami
University of Miami
*Joseph Lamelas
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University of Miami Hospital
University of Miami Hospital
Presenting Author:
Ahmed Alnajar
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University of Miami Hospital
University of Miami Hospital
Abstract:
Introduction: Current literature investigating the role of pre-operative clinical depression on the outcomes of cardiac surgery is often limited to small, single-center studies over a short timeframe, or is isolated to one cardiac surgery approach. This national study examined the outcomes of all cardiac surgery patients over 17 years to better understand the effect of pre-existing depression.
Methods: This study is a retrospective National Inpatient Sample analysis (2001-2018). Patients were included if they were adults (age>18 years) and underwent coronary artery bypass graft (CABG), aortic valve repair (AVR), mitral valve repair (MVR), tricuspid valve repair, and/or ascending aorta repair. Propensity matching for depression based on patient age, sex, and surgery type was performed. Primary outcomes included in-hospital mortality. Secondary outcomes included major adverse cardiac events, and length of stay (LOS).
Results: We matched 302,572 patients with depression to 5,161,521 patients who underwent cardiac surgery and found 298,058 matched patients without depression. Patients with depression had a lower Elixhauser co-morbidity score compared to non-depressed patients. All cardiac patients with depression had less mortality, stroke, and myocardial infarctions, but more complications in the form of bleeding and heart block. Those who underwent CABG had no significant difference in heart block or pacemaker requirements but were more likely to be transferred to other facilities. MVR patients with depression had higher valve complications, heart block, pacemakers, and LOS>2 weeks, but lower mortality and perioperative MI (p<0.05). After adjusting for important factors, MVR has a higher mortality likelihood than isolated CABG (by 63% for isolated MVR, 145% for MVR+CABG, and 166% for MVR+AVR). Depression decreased the likelihood of mortality by 45% (OR: 0.55 [95%CI: 0.48 – 0.62]; p<0.001); however, the interactions of depression with anxiety, obesity, and smoking were significantly associated with an increased likelihood of mortality (Table).
Conclusion: Patients with pre-existing depression had decreased mortality rates, potentially due to established care and awareness of their mental and physical health before admission for cardiac surgery. Surgeons should work with patients and their social support mechanisms to encourage behaviors that promote positive mental and physical health, especially when considering isolated or concomitant MVR.
Methods: This study is a retrospective National Inpatient Sample analysis (2001-2018). Patients were included if they were adults (age>18 years) and underwent coronary artery bypass graft (CABG), aortic valve repair (AVR), mitral valve repair (MVR), tricuspid valve repair, and/or ascending aorta repair. Propensity matching for depression based on patient age, sex, and surgery type was performed. Primary outcomes included in-hospital mortality. Secondary outcomes included major adverse cardiac events, and length of stay (LOS).
Results: We matched 302,572 patients with depression to 5,161,521 patients who underwent cardiac surgery and found 298,058 matched patients without depression. Patients with depression had a lower Elixhauser co-morbidity score compared to non-depressed patients. All cardiac patients with depression had less mortality, stroke, and myocardial infarctions, but more complications in the form of bleeding and heart block. Those who underwent CABG had no significant difference in heart block or pacemaker requirements but were more likely to be transferred to other facilities. MVR patients with depression had higher valve complications, heart block, pacemakers, and LOS>2 weeks, but lower mortality and perioperative MI (p<0.05). After adjusting for important factors, MVR has a higher mortality likelihood than isolated CABG (by 63% for isolated MVR, 145% for MVR+CABG, and 166% for MVR+AVR). Depression decreased the likelihood of mortality by 45% (OR: 0.55 [95%CI: 0.48 – 0.62]; p<0.001); however, the interactions of depression with anxiety, obesity, and smoking were significantly associated with an increased likelihood of mortality (Table).
Conclusion: Patients with pre-existing depression had decreased mortality rates, potentially due to established care and awareness of their mental and physical health before admission for cardiac surgery. Surgeons should work with patients and their social support mechanisms to encourage behaviors that promote positive mental and physical health, especially when considering isolated or concomitant MVR.
Mitral Conclave:
Perioperative Care
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