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

Abstract

Background 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. Methods 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 30 day emergency hospital readmissions. Predictors of these health outcomes were also assessed. Results 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. Conclusion Patients with depression undergoing vascular surgery have substantially poorer health outcomes. Screening for depression prior to surgery might be indicated to target preventative measures.

Cardiac surgery receipt and outcomes for people using secondary mental healthcare services: Retrospective cohort study using a large mental healthcare database in South London

“…Previous studies, including our own work, have suggested that postoperative surgical outcomes are commonly worse in patients with mental health problems [ 10 , 11 ]. They may therefore constitute a potentially high-risk group for adverse outcomes after cardiac surgery.…”

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

“…Readmissions were found to be generally increased in patients with MHD. 4,9,14,17,20,23,30,33-35 Notably, patients with MHD undergoing general surgery procedures had a 14.5% chance of readmission compared to 3.7% for those without MHD (P = .009). 9 Similarly, Litz, et al, conducted a retrospective analysis on 30-day readmission rates of bariatric surgery patients who had MHD and found a 34% greater odds of readmission on average in those with MHD compared to those without MHD (OR 1.34, 95% CI 1.19-1.51).…”

“…Some studies found MHD negatively impacted mortality. 17,33,36-38 Notably, Abrams, et al’s, study focused on surgical mortality and found those with an MHD had a higher 30-day mortality (OR 1.21, 95% CI 1.07-1.37, P = .003). However, their analysis also included cardiothoracic procedures and extracranial neurosurgical procedures in addition to general surgery procedures.…”

2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

“…12,32–34 Depression has been recognized as a prevalent comorbidity among patients with PAD and has recently been associated with higher rates of MACE and MALE outcomes, as well as outcomes such as length of stay and readmission after revascularization. 35–40 Simple tools such as the Geriatric Depression Score (GDS) or the Patient Heath Questionnaire (PHQ)-9 can be used to assess for depression. 41,42…”