The impact of preoperative depression on in-hospital outcomes in coronary artery bypass grafting: A propensity-matched analysis of National Inpatient Sample from 2015-2020.

Abstract

Background: Depression has a high prevalence among patients undergoing coronary artery bypass grafting (CABG). However, there is a scarcity of literature on the association between preoperative depression and CABG outcomes. This study aimed to explore the effects of preoperative major depression disorder (MDD) on in-hospital outcomes following CABG.

Methods: Patients who underwent CABG were identified in National Inpatient Sample from the last quarter of 2015 to 2020. Patients were stratified based on the diagnosis of MDD, followed by a 1:3 propensity-score matching of demographics, socioeconomic status, comorbidities, relevant diagnosis, admission status, and hospital characteristics between MDD and non-MDD patients. In-hospital perioperative outcomes, total length of stay (LOS), time from admission to operation, and total hospital charge were compared.

Results: There were 908 patients with MDD and 170,830 patients without MDD who underwent CABG. After propensity-score matching, 2,796 non-MDD were matched with all 908 MDD patients. While MDD patients have no difference in-hospital mortality or MACE, they had higher hemorrhage/hematoma (65.97 % vs 60.17 %, p < 0.01) and pacemaker implantation (2.53 % vs 1.43 %, p = 0.04). MDD patients had longer time from admission to operation (3.2 ± 0.1 vs 2.6 ± 0.2 days, p < 0.01), longer total LOS (12.6 ± 0.5 vs 10.5 ± 0.2 days, p < 0.01), and higher total hospital charge (272,255.0 ± 8930.1 vs 230,133.0 ± 3861.1 US dollars, p < 0.01).

Conclusion: Potential barriers could exist for MDD patients seeking access to CABG. Preoperative MDD is a risk factor for complications following CABG including hemorrhage/hematoma and pacemaker implantation. Enhanced attention to coagulation function is advisable for MDD patients prior to CABG.