53: Effect of preoperative depression on length of stay and disposition following pelvic reconstructive surgery

Abstract

To evaluate the effect of preoperative depression on length of stay and disposition following pelvic reconstructive surgery (PRS). Data from the Healthcare Cost and Utilization Project National Inpatient Sample was used to identify women undergoing PRS between 2012 to 2016. Patient- and hospital-level demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and those without pre-existing depression. Descriptive statistics are expressed as medians and interquartile ranges (IQR). Pairwise analysis was performed between groups using Wilcoxon rank-sum or Fisher’s exact test. Multivariable logistic regression was used to identify independent risk factors for non-home dispositions and for length of stay greater than the median for the cohort. Non-home disposition was defined as transfer to a different acute care facility, non-hospital care facility, skilled nursing facility or discharge with home health. During the study period 52,541 patients underwent PRS and 9.1% had depression. Patients with depression were younger median age (57 (IQR: 47-67) vs 58 (46-68), p <0.003), less likely to be white (14.0% vs 23.4%, p<0.001), and more likely to live in areas with more than 1 million people (22.5% vs 28.0%, p<0.001). They were also more likely to have higher Elixhauser comorbidity index (4 IQR: 4-12 vs 0 (IQR: -1 to 5, p<0.001). There were no differences between type of surgery, except that patients with depression were more likely to undergo an anterior or posterior repair (91.4% vs 87.6%, p=0.03). On pairwise analysis, patients with depression were more likely to be discharged to a non-home destination (6.5% vs 4.5%, p<0.001) and have a longer length of stay (2 days IQR: 1-3 vs 1-day IQR: 1-2, p=0.01). The median length of stay for the entire cohort was 1 day (IQR: 1-2). After logistic regression, depression was not found to be an independent predictor of non-home discharge. Colpocleisis was the strongest predictor, (aOR=2.72, 95% CI: 1.80-4.11), followed by transfusion (aOR=2.05, 95% CI: 1.29 – 3.23), having Medicare as primary payor (aOR=1.83, 95% CI: 1.32-2.54), an increasing Elixhauser index (aOR=1.05 per point, 95% CI: 1.03 – 1.06), and increasing age (aOR=1.04 per year, 95% CI: 1.02-1.06). Higher median household incomes were associated with a lower likelihood of non-home discharge (aOR=0.81, 95% CI: 0.73-0.90). Depression was not independently associated with a hospitalization greater than 1 day. Blood transfusion (aOR=4.47, 95% CI: 2.71-7.36), increasing age (aOR=1.06 per year 95% CI: 1.05-1.07), increasing Elixhauser index (aOR=1.04, 95% CI: 1.03-1.05), Medicare as primary payor (aOR=1.81, 95% CI: 1.52-2.14), and vaginal colpopexy (aOR: 1.21, 95% CI: 1.04-1.43) were associated prolonged stay. Pre-existing depression is not independently associated with non-home discharge or prolonged length of stay after PRS.