title: Depression is associated with prolonged and complicated recovery following colorectal surgery.
abstract: BACKGROUND
  There are little data regarding the impact of depression on outcomes after gastrointestinal surgery. We hypothesize that depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery.
  
  
  METHODS
  We identified 292,191 patients undergoing colon and rectal surgery using the 2008 Nationwide Inpatient Sample. We used multivariate regression to evaluate the effect of depression on length of stay and discharge disposition.
  
  
  RESULTS
  A preoperative diagnosis of depression was present in 20,039 (6.9%) patients. Mean length of stay for those with depression (10.4 days, 95% confidence interval (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 cofounders, depression still predicted an increase in length of stay. Additionally, depressed patients were less likely to resume normal function at discharge, 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 and higher likelihood of requiring skilled nursing assistance after discharge. Further research into the mechanism underlying these differences and potential treatment strategies among depressed patients is warranted.
authors.affiliation: Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Balentine
authors.forename: Jesus
authors.initials: J
authors.lastname: Hermosillo-Rodriguez
authors.forename: Celia N
authors.initials: CN
authors.lastname: Robinson
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
mesh_terms: D003108:Colonic Diseases / Q000523:psychology / Q000601:surgery*; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications; D012002:Rectal Diseases / Q000523:psychology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome