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Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

Authors

  • Tam K. Dao PhD,

    1. Department of Educational Psychology, University of Houston, Houston, Texas
    2. Michael E. DeBakey Veterans Affairs Medical Center, Department of Surgery, Houston, Texas
    3. Baylor College of Medicine, and the Department of Psychiatry and Behavioral Sciences, Houston, Texas
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  • Danny Chu MD,

    1. Department of Educational Psychology, University of Houston, Houston, Texas
    2. Baylor College of Medicine, and the Division of Cardiothoracic Surgery, Houston, Texas
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  • Justin Springer PhD,

    1. Michael E. DeBakey Veterans Affairs Medical Center, Department of Surgery, Houston, Texas
    2. Baylor College of Medicine, and the Department of Psychiatry and Behavioral Sciences, Houston, Texas
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  • Emily Hiatt BA,

    1. Department of Educational Psychology, University of Houston, Houston, Texas
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  • Quang Nguyen PhD

    1. Michael E. DeBakey Veterans Affairs Medical Center, Department of Surgery, Houston, Texas
    2. Baylor College of Medicine, and the Department of Psychiatry and Behavioral Sciences, Houston, Texas
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  • For further information, contact: Tam K. Dao, PhD, University of Houston, Michael E. DeBakey Veterans Affairs Medical Center, & Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030; e-mail tam.dao@va.gov.

Abstract

Purpose: 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.

Findings: 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.

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