title: Association between preoperative depression and long-term survival following coronary artery bypass surgery - A systematic review and meta-analysis.
abstract: BACKGROUND
  Depression is common in patients with cardiovascular disease. The importance of preoperative depression for long-term survival following coronary artery bypass grafting (CABG) is not well known. The aim was to provide a summary estimate of the association between preoperative depression and long-term survival in adults who underwent CABG.
  
  
  METHODS
  We did a systematic search of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Science, and PubMed from inception to November, 2015, including cohort studies with at least one month of follow-up that reported hazard ratios (HR) and 95% confidence intervals (CI) for long-term all-cause mortality following CABG in patients with preoperative depression compared to non-depressed patients. Two reviewers independently extracted data on populations, exposure, outcome, risk of bias, and quality of evidence. We calculated HR and 95% CIs for all-cause mortality using random-effects meta-analyses and performed subgroup and sensitivity analyses.
  
  
  RESULTS
  Seven studies were included with a combined study population of 89,490 patients (4002 depressed/85,488 non-depressed). All studies observed a positive association between preoperative depression and all-cause mortality, and in 4 studies the association was statistically significant. Patients with depression had a pooled hazard ratio of 1.46 (95% CI: 1.23-1.73, p<0.0001) for all-cause mortality with moderate heterogeneity (I(2)=50.1%, p=0.061).
  
  
  CONCLUSIONS
  This systematic review and meta-analysis indicates that patients with preoperative depression are at increased risk for long-term, all-cause mortality following CABG compared with those without depression. Systematic screening for depression prior to cardiac surgery could identify those at higher risk.
authors: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. Electronic address: Malin.Stenman@ki.se.
authors: Malin
authors: M
authors: Stenman
authors: Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Martin J
authors: MJ
authors: Holzmann
authors: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors: Ulrik
authors: U
authors: Sartipy
mesh_terms: D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality* / Q000639:trends; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D003866:Depressive Disorder / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D011300:Preoperative Care / Q000379:methods / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Coronary artery bypass grafting; Depression; Meta-analysis; Survival; Systematic review