Depression Is Associated With Prolonged and Complicated Recovery Following Colorectal Surgery
Courtney J. Balentine*1,2, Aanand D. Naik1,2, Celia N. Robinson3,2, Jesus H. Hermosillo-Rodriguez4, David H. Berger1,2
1Houston VA HSR&D Center of Excellence, Houston, TX; 2Michael E DeBakey VA Hospital, Houston, TX; 3Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; 4Internal Medicine, Baylor College of Medicine, Houston, TX
BACKGROUND
Although depression is increasingly common among hospitalized patients, little data exists regarding the impact on surgical outcomes. Since recovery from major abdominal surgery is both physically and emotionally challenging, preexisting depression may complicate this process by prolonging hospital stays and delaying functional recovery. We hypothesized that co-morbid depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery.
METHODS
Patients age 18 or older undergoing colon and rectal surgery were identified from the 2008 Nationwide Inpatient Sample. Proportions were compared using chi-square. Individuals with depression were identified from the Severity File and compared to non-depressed patients using multiple linear regression accounting for clustering by hospital and adjusting for clinical and sociodemographic confounders.
RESULTS
The 2008 NIS cohort included 292,191 patients who underwent colon or rectal surgery. A preoperative diagnosis of depression was present in 20,039 (6.9%) patients. Individuals with depression were more likely to be younger (mean age 63.2 vs 62.1, p<0.001), female (70% vs 52%, p<0.001), white (87% vs 80%, p<0.001), and to have had preoperative weight loss (11% vs 8%, p<0.001) compared to patients without a diagnosis of depression. Mean length of stay for those with depression (10.4 days, 95% CI 10.04-10.76) was significantly longer than for patients without depression (9.64 days, 95% CI 9.48-9.81). After adjusting for comorbidities using the Deyo Index, sociodemographic factors, age, insurance status, race, and surgical and hospital variables, depression still predicted an increase in length of stay. Additionally, depressed patients were less likely to resume normal function at the end of their prolonged stay, as 40% required either home health or time in a skilled facility following discharge from the acute care hospital.
CONCLUSIONS
Among patients undergoing colorectal surgery, depression is associated with a significantly prolonged hospital stay. At the same time, patients with depression are more likely to require assistance after discharge in the form of home health services or time in skilled rehabilitation facilities. The need for assistance after discharge adds to an already protracted recovery and can significantly increase cost of care. Further research into the mechanism underlying these differences and potential treatment strategies among depressed patients is warranted .
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