David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Division of Cardiac Surgery, David Geffen School of Medicine, University of California at Los Angeles, UCLA Center for Health Sciences, Los Angeles, California.
J Surg Res. 2019 Jan;233:50-56. doi: 10.1016/j.jss.2018.07.062. Epub 2018 Aug 17.
Depression affects between 10% and 40% of cardiac surgery patients and is associated with significantly worse outcomes. The incidence and impact of new-onset depression beyond acute follow-up remain ill-defined. The present study aimed to evaluate the incidence, risk factors, and prognostic implication of depression on 90-d readmission rates after coronary artery bypass grafting (CABG) surgery.
A retrospective cohort study was performed identifying adult patients without prior depression who underwent CABG surgery using the 2010-2014 National Readmissions Database. CABG patients who were readmitted more than 2 wk but within 90 d of discharge were categorized based on the presence of new-onset depression. Association between the development of new-onset depression and rehospitalization were morbidity, mortality, costs, and length of stay (LOS) and were examined using multivariable regression.
During the study period, 1,001,945 patients underwent CABG. Of these, 11.7% of patients were readmitted after 14 d but within 90 d of discharge with 5.1% of these patients having a diagnosis of new-onset depression. Postoperative new-onset depression was not associated with increased readmission morbidity, costs, or LOS. Mortality in new-onset depression readmissions was 1.2%, compared with 2.3% in all readmitted patients (P = 0.014). Depression was associated with lower odds of mortality (OR = 0.56, P = 0.02).
New-onset depression following CABG discharge was not associated with increased odds of mortality, morbidity, costs, or increased LOS on readmission. Rather, new-onset depression is associated with decreased odds of readmission mortality. Overall, CABG readmissions are decreasing, whereas the rate of new-onset depression is slightly increasing. Implementation of routine depression screening tools in postoperative CABG care may aid in early detection and management of depression to enhance postoperative recovery and quality of life.
抑郁症影响 10%至 40%的心脏手术患者，与预后显著恶化相关。心脏手术后急性随访期之外新发抑郁的发生率和影响仍未明确。本研究旨在评估冠状动脉旁路移植术（CABG）后 90 天内再入院率的新发抑郁发生率、风险因素及预后意义。
采用回顾性队列研究，通过 2010 年至 2014 年国家再入院数据库，识别无既往抑郁的行 CABG 手术的成年患者。将出院后 2 周以上但在 90 天内再入院的 CABG 患者根据新发抑郁的发生情况进行分类。使用多变量回归分析新发抑郁与再入院之间的关联性，并分析再入院的发病率、死亡率、成本、住院时间（LOS）。
研究期间，1001945 例行 CABG 手术。其中，11.7%的患者在出院后 14 天但在 90 天内再次入院，其中 5.1%的患者诊断为新发抑郁。术后新发抑郁与再入院发病率、成本或 LOS 增加无关。新发抑郁再入院的死亡率为 1.2%，而所有再入院患者的死亡率为 2.3%（P=0.014）。抑郁与较低的死亡风险相关（OR=0.56，P=0.02）。
CABG 出院后新发抑郁与死亡率、发病率、成本或再入院 LOS 增加无关。相反，新发抑郁与再入院死亡率降低相关。总体而言，CABG 再入院率在下降，而新发抑郁率略有上升。在术后 CABG 护理中实施常规抑郁筛查工具可能有助于早期发现和管理抑郁，从而促进术后康复和生活质量。
