Patients with depression ‘less likely’ to go home after CLTI revascularization

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A recent analysis established an association between depression and non-home discharge after revascularization for chronic limb-threatening ischemia (CLTI)—providing further evidence, the authors say, that an increased awareness of mental health is fundamental to care for vascular surgery patients.

Joel L. Ramirez, a resident in the division of vascular and endovascular surgery at the University of California, San Francisco, James C. Iannuzzi, MD, a vascular surgeon in the same department, and colleagues write in an online Journal of Vascular Surgery (JVS) article that these results “provide further evidence of the negative impact that comorbid depression has on patients undergoing revascularization for CLTI,” and propose that future studies should examine whether treating depression can improve outcomes in this patient population.

“Recent evidence suggests that depression in patients with peripheral arterial disease (PAD) is associated with increased postoperative complications,” the authors begin, noting that problems can include decreased primary and secondary patency after revascularization and increased risk of major amputation and mortality.

Ramirez et al note that the impact of depression on non-home discharge after vascular surgery remains unexplored, despite this being “an important outcome” for patients. They hypothesized that depression would be associated with an increased risk for non-home discharge following revascularization for CLTI.

The investigators identified endovascular, open, and hybrid cases of revascularization for CLTI from the 2012–2014 National (Nationwide) Inpatient Sample, which they explain is “a patient-level administrative claims database that is published annually by the Agency for Healthcare Research and Quality and represents approximately 20% of discharges from U.S. hospitals.” They write that a hierarchical multivariable binary logistic regression controlling for hospital level variation examined the association between depression and non-home discharge and controlled for confounders meeting p<0.01 on bivariate analysis.

They identified 64,817 cases, of which 5,472 (8.4%) were diagnosed with depression, and 16,524 (25.5%) required non-home discharge.

The researchers relay that patients with depression were younger, more likely to be women, white, have multiple comorbidities, a non-elective admission, and experience a postoperative complication.

The authors report that, on unadjusted analyses, patients with depression had a 7% absolute increased risk of requiring non-hospital discharge (32.1% vs. 24.9%, p<0.001).

On multivariable analysis, they found that patients with depression had an adjusted 50% increased odds for non-hospital discharge (odds ratio [OR]=1.5; 95% confidence interval [CI]=1.4–1.61; c-statistic, 0.81) compared to those without depression.

After stratification by operative approach, Ramirez et al identified that 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=1.3–1.62).

SOURCE: DOI.ORG/10.1016/J.JVS.2020.12.079

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