A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London.

Sajini Kuruppu,Gayan Perera,Ruwan Weerakkody,Robert Stewart,Megan Pritchard,Marvey Ghani,Matthew Harris

doi:10.1192/j.eurpsy.2021.2

Abstract

Patients with depression are more susceptible to cardiovascular illness including vascular surgeries. However, health outcomes after vascular surgery among patients with depression is unknown. This study aimed to investigate associations of depression with post-operative health outcomes for vascular surgical patients. A retrospective observational study was conducted using data from a large mental healthcare provider and linked national hospitalization data for the same south London geographic catchment. OPCS-4 codes were used to identify vascular procedures. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30day emergency hospital readmissions. Predictors of these health outcomes were also assessed. Vascular surgery was received by 9,267 patients, including 446 diagnosed with depression. Patients with depression had a higher risk of emergency admission for vascular surgery (odds ratio [OR] 1.28; 1.03, 1.59), longer index LOS (IRR 1.38; 1.33-1.42), and a higher risk of 30-day emergency readmission (OR 1.82; 1.35-2.47). Patients with depression had higher inpatient mortality after adjustment for sociodemographic status (1.51; 1.03, 2.23) but not on full adjustment, and had longer emergency readmission LOS (1.13; 1.04, 1.22) after adjustment for sociodemographic factors and cardiovascular disease. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.

Highlights

Depression has a high prevalence among patients with cardiovascular disease (CVD), including coronary heart disease and peripheral arterial disease (PAD) [1, 2]
This study investigated admission rates and post-operative health outcomes of vascular surgery for patients with depression compared to the general population, and to estimate key predictors of these outcomes
Patients with depression had a higher likelihood of emergency rather than elective index admission, a longer index hospital length of hospital stay (LOS) for vascular surgery and a higher risk of 30-day emergency hospital readmission, after taking into account a wide range of potential confounding factors

Summary

Introduction

Depression has a high prevalence among patients with cardiovascular disease (CVD), including coronary heart disease and peripheral arterial disease (PAD) [1, 2]. It is reported that individuals with depression may only decide to seek medical advice when their illness has progressed significantly, and when they do, they may be less likely to follow the recommendations offered to them by clinicians [12, 13] This poor communication between clinicians and patients may result in treatment being delayed even further [12]. Health outcomes were compared between those with/without depression including length of hospital stay (LOS), inpatient mortality, and 30 day emergency hospital readmissions. Predictors of these health outcomes were assessed. Correlates of vascular surgery hospitalization among patients with depression included admission through emergency route for longer LOS, inpatient mortality, and 30-day hospital readmission. Screening for depression prior to surgery might be indicated to target preventative measures

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