Abstract

While often overlooked during preoperative evaluation, recent evidence suggests that depression in patients with peripheral arterial disease (PAD) is associated with increased postoperative complications including decreased primary and secondary patency after revascularization and increased risk of major amputation and mortality. Post-operative non-home discharge (NHD) is an important outcome for patients and has also been associated with other adverse outcomes, but the impact that depression has on NHD after vascular surgery remains unexplored. We hypothesized that depression would be associated with an increased risk for NHD following revascularization for chronic limb threatening ischemia (CLTI).Endovascular, open, and hybrid (combined open and endovascular) cases of revascularization for CLTI were identified from the 2012-2014 National (Nationwide) Inpatient Sample. CLTI, diagnoses of depression, and medical comorbidities were defined using corresponding ICD-9 codes. A hierarchical multivariable binary logistic regression controlling for hospital level variation examined the association between depression and NHD and controlled for confounders meeting P<0.01 on bivariate analysis. A sensitivity analysis after coarsened exact matching (CEM) for baseline characteristics that differed between the two groups was done to reduce imbalance.There were 64,817 cases identified, of which 5,472 (8.4%) were diagnosed with depression, and 16,524 (25.5%) required NHD. Patients with depression were younger, more likely to be women, white, have multiple comorbidities, a non-elective admission, and experience a postoperative complication (P<0.05). On unadjusted analyses, patients with depression had an 8% absolute increased risk of requiring NHD (32.1% vs 24.9%, P<0.001). On multivariable analysis, patients with depression had an increased odds for NHD (OR=1.50; 95% CI=1.40-1.61, c-statistic=0.81) compared to those without depression. After stratification by operative approach, depression had a larger effect estimate in endovascular revascularization (OR=1.57; 95% CI=1.42-1.74) compared to open (OR=1.45; 95% CI=1.30-1.62). A test for interaction between depression and gender identified that men with depression had higher odds of NHD compared to women with depression (OR=1.68, 95% CI=1.51-1.88 vs OR=1.37, 95% CI=1.25-1.51; interaction P<0.01). A sensitivity analysis after CEM confirmed these findings.To our knowledge, this is the first study to identify an association between depression and NHD after revascularization for CLTI. These results provide further evidence of the negative impact that comorbid depression has on patients undergoing revascularization for CLTI. Future study should examine whether treating depression can improve outcomes in this patient population.

View details for DOI 10.1016/j.jvs.2020.12.079

View details for PubMedID 33383108