P266. Preoperative Depression is Associated with Higher Risk of Bleeding in Type A Aortic Dissection Repair: A Population Study of National Inpatient Sample from 2015-2020
Minneapolis, MN
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Dr. Huddleston joined the faculty at the University of Minnesota in December 2015 where he is an Associate Professor of Surgery in the Division of Cardiothoracic Surgery, and the Surgical Director of the Lung Transplant Program at the University of Minnesota Medical Center. As such, his primary academic interest is in lung transplantation with a focus on clinical outcomes and transplant immunology, as well as ex vivo lung perfusion. He has been the site principal investigator for two multicenter clinical trials examining the role of warm ex vivo lung perfusion in lung transplant. The device used for this research, TransMedics Lung OCS, is now FDA approved and expanding the donor pool. Also, he collaborates with world-renowned immunologist Marc Jenkins, PhD using advanced immunologic techniques to detect and characterize CD4+ T cells with specificity for the donor lung in the blood of lung transplant recipients. He is also the Director of the Aortic Center with a strong interest in aortic dissection, repair of thoracic and thoracoabdominal aortic aneurysms, and surgical outcomes after aortic surgery. In addition, he is the Chief of Cardiac Surgery at St. Johns Hospital in Maplewood, MN.
Dr. Huddleston received his medical degree from Columbia University in 2000 and completed his internship and residency in General Surgery at the University of Minnesota. Dr. Huddleston received his Ph.D. in surgery at University of Minnesota in 2009 defending his thesis, “Graft Antigen-Specific CD4+ T cells require CD154 Expression to Clonally Expand and Differentiate to the Th1 phenotype and initiate mTOR Dependent Intimal Hyperplasia in Cardiac Allografts.” After completing his cardiothoracic surgery training at the Johns Hopkins Hospital in Baltimore, MD, he was a private practice cardiothoracic surgeon at St. Luke’s Hospital in Duluth, MN starting in 2012 until he returned to the University of Minnesota. He is board certified in Surgery and Thoracic Surgery.
Description
Methods. Patients undergoing TAAD repair were identified in NIS from the last quarter of 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients with and without preoperative depression, adjusted for demographics, comorbidities, hospital characteristics, primary payer status, and transfer status.
Results. There were 321 (7.50%) patients with depression and 3,961 (92.50%) non-depressive patients who went under TAAD repair. Patients with and without depression had comparable in-hospital mortality (11.84% vs 15.37%, p=0.35). However, Patients with depression had a higher risk of hemorrhage/hematoma (83.49% vs 76.6%, aOR 1.593, 95 CI 1.161-2.184, p<0.01) and a higher rate of transfer out (40.81% vs 32.62%, aOR 1.396, 95 CI 1.077-1.81, p=0.01). All other in-hospital complications, hospital length of stay (LOS), and total hospital charge were all comparable between patients with and without depression.
Conclusion. Preoperative depression is associated with a higher risk of bleeding after TAAD repair. This may be due to anti-depression treatment, such as Selective Serotonin Reuptake Inhibitors (SSRIs), that can disrupt platelet function and lead to abnormal bleeding. While preoperative depression is not associated with other major outcomes, preoperative screening for depression before TAAD and corresponding preoperative blood management may be helpful in avoiding bleeding complications in patients with depression
Authors
Renxi Li (1), Qianyun Luo (2), Stephen Huddleston (2)
Institutions
(1) The George Washington University, Washington, DC, (2) University of Minnesota, Minneapolis, MN