Depression and geographic status as predictors for coronary artery bypass surgery outcomes.
OBJECTIVE
To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery.


METHODS
Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We analyzed 7 demographic variables, 19 preoperative medical and psychiatric variables, and 2 outcome variables (ie, in-hospital mortality and length of stay). Logistic regression and multivariable regression analyses were used to assess urban-rural status and depression as independent predictors of in-hospital mortality and length of stay.


RESULTS
Rural patients were more likely to have a comorbid depression diagnosis compared to urban patients (urban = 19.4%, rural = 21.4%, P < .001). After adjusting for confounding factors, having a comorbid depression diagnosis (B= 1.10, P < .001) and residing in a rural area (B= .986, P < .05) were associated with an increased length of in-hospital stay following CABG surgery. Furthermore, having a depression diagnosis (OR = 1.63, 95% CI = 1.45-2.21) and residing in a rural area (OR = 1.43, 95% CI = .896-1.45) were associated with an increased likelihood of in-hospital mortality.


CONCLUSIONS
Rural patients were more likely than urban ones to have a depression diagnosis. Depression was a significant independent predictor of both in-hospital mortality and length of stay for patients receiving CABG surgery. Also, rural patients had increased lengths of in-hospital stay as well as in-hospital mortality rates compared to those who resided in urban areas.
Dao
Tam K
TK
Department of Educational Psychology, University of Houston, Houston, TX 77030, USA. tam.dao@va.gov
Chu
Danny
D
Springer
Justin
J
Hiatt
Emily
E
Nguyen
Quang
Q
D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003863:Depression / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005843:Geography; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014505:Urban Population / Q000706:statistics & numerical data