Abstract
Background:
Hip fractures are a common source of disability in older adults. Depression, which is also prevalent in the elderly, has been correlated with negative surgical outcomes in other fields. The purpose of this study was to determine how hip fracture postoperative morbidity and mortality differ in older adults with depression compared with those without depression.
Methods:
The National Inpatient Sample was queried from 2016 to 2021 for patients aged 65 years and older who were treated surgically for a hip fracture. Outcomes for patients with depression were compared with those without depression using univariate and multivariable regression models after accounting for demographic variables and comorbidities. The primary outcome was inpatient mortality. Secondary outcomes include deep vein thrombosis or pulmonary embolism (DVT/PE), myocardial infarction, infection, discharge disposition, length of stay, and total charges.
Results:
A total of 307,377 patients were identified as having a hip fracture surgically repaired from 2016 to 2021 of whom 48,556 (15.8%) were depressed. Patients with depression were more likely to be female (76.3% and 68.6%, P < 0.01) and White (90.5% and 86.1%, P < 0.01). On multivariable regression analysis, patients with depression were more likely to experience inpatient mortality (odds ratio [OR]: 1.13 to 1.33, P < 0.01), DVT/PE (OR: 1.03 to 1.23, P = 0.01), and myocardial infarction (OR: 1.02 to 1.19, P = 0.02) than patients without depression. Patients with depression were also less likely to experience a routine discharge (OR: 0.62 to 0.66, P < 0.01) and were more likely to experience a longer length of stay (β coefficient 95% confidence interval, 0.46 to 0.54, P < 0.01) and greater total charges (β coefficient 95% confidence interval, 2,511 to 3,716, P < 0.01) than patients without depression.
Conclusions:
Patients with depression experienced increased odds of adverse events during their hospitalization including inpatient mortality, DVT/PE, and myocardial infarction. The lower odds of routine discharge and longer length of stay in depressed patients suggest that they may face a more difficult recovery process after surgery. Additional research is warranted to determine how long-term surgical outcomes are affected by depression and how interventions can influence these outcomes.
Hip fractures are a common source of morbidity and mortality in the elderly, especially those with osteoporosis. The incidence of hip fractures was 741 per 100,000 adults in the United States in 2015,1 and the lifetime risk of a hip fracture is estimated to be 23.3% for men and 11.2% for women.2 Hip fractures result in a loss of independence, decreased mobility, and reduced quality of life for older patients.2 Despite improvements in the surgical treatment of hip fractures over the past several decades, the morbidity and mortality from these injuries have remained relatively unchanged.3
Although the effects of comorbid conditions such as liver disease, congestive heart failure, and end-stage renal disease have been studied,4,5 limited research exists concerning the effect of depression on the surgical outcomes of hip fractures.6 Depression is common in older adults with more than a quarter of adults older than 55 meeting criteria for either major depressive disorder or subsyndromal depression.7,8 Studies from other fields have found that depression may influence surgical outcomes for bariatric, spine, and cardiac surgery.9-11 Depression can increase the risk of hip fracture directly by 20 to 25% and indirectly by being a risk factor for osteoporosis.12,13 Limited research has been done to explore the effect of depression on short-term surgical outcomes. However, several studies have found that depression is a predictor of poor outcomes for rehabilitation after surgery for hip fractures.14,15
The goal of this study was to determine how hip fracture postoperative outcomes differ in older adults with depression compared with those without depression. We hypothesized that patients with depression would experience increased morbidity and mortality after hip fracture repair than patients without depression. The primary outcome is inpatient mortality; secondary outcomes include deep vein thrombosis or pulmonary embolism (DVT/PE), myocardial infarction, infection, discharge disposition, length of stay, and total charges.
Methods
Data Source
This was a large database study based on the National Inpatient Sample (NIS), a database which was developed for the Healthcare Cost and Utilization Project.16 The NIS is the largest inpatient database available in the United States, and it includes data from approximately 20% of hospitals, regardless of payer. The NIS database includes deidentified information during inpatient hospital stays, including International Classification of Disease, 10th edition, clinical modification (ICD-10-CM) billing codes, procedure codes, demographic information, total charges, and payer information.
Cohort Selection
The NIS database from 2016 to 2021 was queried for patients who had a hip fracture listed as their primary, secondary, or tertiary diagnosis. A full list of ICD-10-CM codes used for filtering is included in Appendix A, http://links.lww.com/JG9/A512 (adapted from Hassan et al17). Patients aged 65 years and older were included. The data were filtered for patients who were treated surgically; patients who did not have one of these procedures (Appendix A, http://links.lww.com/JG9/A512) listed as one of their first five procedure codes were excluded.
Variable Definitions
The primary variable of interest in this study was depression. Patients with depression were defined using the “comorbidity” package in R,18 which sorts through ICD-10-CM codes to identify patients who were diagnosed with a depressive disorder. Other variables that were included in analyses as covariates include age, sex, race (White, Black, Hispanic, or Other), Elixhauser Comorbidity Index (ECI), and orthopaedic frailty score (OFS). The outcome variables were inpatient mortality, DVT/PE, myocardial infarction, infection, discharge disposition, length of stay, and total charges.
The ECI is a sum of 30 dichotomous categories of comorbidities and can be used to predict hospital resource allocation and patient outcomes.19 The OFS is a newly proposed metric to predict postoperative outcomes in hip fracture patients.20 The score ranges from 0 to 5, and one point is assigned each for patients who are 85 years or older, have congestive heart failure, have a history of malignancy, are institutionalized, and have nonindependent functional status. Patients with congestive heart failure or a history of malignancy were identified using the “comorbidity” package (lymphoma, metastatic cancer, and solid tumors were included as malignancies). Patients were considered institutionalized if they were transferred in from another facility (TRAN_IN), and they were considered to have nonindependent functional status if they had moderate loss of function or greater (APRDRG_Severity). Routine discharge was defined as home or home health; other discharge dispositions were defined as nonroutine (DISP_UNIFORM).
Statistical Analyses
All data manipulation and statistical analyses were done in R Studio. Univariate analyses were done with the “tableby” function from the “arsenal” package in R. Patients with depression were compared with the rest of the cohort in age, sex, race, ECI, OFS, and rates of congestive heart failure, liver disease, obesity, fluid and electrolyte abnormalities, hypertension, and diabetes (individual components of the ECI). Chi square tests were used for categorical variables, and T-tests were used for continuous variables. P-values less than 0.05 were considered to be statistically significant. Next, the outcomes for patients with depression were compared with the remainder of the sample. The outcomes that were measured include inpatient mortality, DVT/PE, myocardial infarction, infection, discharge disposition (routine or nonroutine), length of stay, and total charges.
Then, multivariable regression models were created using the “glm” function to determine the effect of depression on patient outcomes after accounting for the variables that were significantly different in patients with depression (Table 1). The models include depression, age, sex, race, and ECI as covariates. Although rates of congestive heart failure, liver disease, obesity, hypertension, and diabetes were significantly different between cohorts, they were not included in the models because these are components of the ECI and are not strictly independent variables. Multiple linear regression (beta coefficients) is used for continuous variables, and multiple logistic regression (odds ratios) is used for categorical variables. Note that although the directionality of relationships described with odds ratios is interpreted about 1, relationships described with beta coefficients are interpreted about 0.
Table 1.
Demographics of Patients Who Underwent Surgery for a Hip Fracture Between 2016 and 2021 With and Without Depression
| Factor or Variable | Not depressed (N = 258,821) | Depressed (N = 48,556) | P Value |
| Age: mean (SD) | 81.5 (7.5) | 80.1 (7.6) | <0.01 |
| Sex | <0.01 | ||
| Male | 81,306 (31.4%) | 11,496 (23.7%) | |
| Female | 177,485 (68.6%) | 37,056 (76.3%) | |
| Race | |||
| White | 216,984 (86.1%) | 42,728 (90.5%) | <0.01 |
| Black | 10,056 (4.0%) | 1,085 (2.3%) | <0.01 |
| Hispanic | 14,012 (5.6%) | 2,076 (4.4%) | <0.01 |
| Other | 11,041 (4.4%) | 1,344 (2.8%) | <0.01 |
| Elixhauser Comorbidity Score: mean (SD) | 8.3 (7.8) | 5.5 (7.7) | <0.01 |
| Orthopaedic Frailty Score | |||
| 0 | 41,851 (16.2%) | 7,171 (14.8%) | <0.01 |
| 1 | 98,085 (38.1%) | 19,562 (40.5%) | <0.01 |
| 2 | 81,736 (31.7%) | 14,993 (31.0%) | <0.01 |
| 3 | 31,611 (12.3%) | 5,750 (11.9%) | 0.03 |
| 4 | 4,372 (1.7%) | 826 (1.7%) | 0.84 |
| 5 | 113 (0.0%) | 20 (0.0%) | 0.81 |
| Congestive heart failure | 49,087 (19.0%) | 9,447 (19.5%) | 0.01 |
| Liver disease | 5,462 (2.1%) | 1,172 (2.4%) | <0.01 |
| Obesity | 13,975 (5.4%) | 3,749 (7.7%) | <0.01 |
| Fluid and electrolyte abnormalities | 82,149 (31.7%) | 15,604 (32.1%) | 0.09 |
| Hypertension | 198,031 (76.5%) | 38,011 (78.3%) | <0.01 |
| Diabetes | 61,643 (23.8%) | 12,217 (25.2%) | <0.01 |
DVT = deep vein thrombosis, PE = pulmonary embolism
The bold entries represent statistically significant differences (p<0.05).
Finally, models were created to predict the utility of the ECI and OFS in predicting patient outcomes after surgical repair of hip fractures. For each outcome variable, a separate model was created using the ECI or OFS as a predictor variable. Covariates include age, sex, and race in both models.
Results
Demographics
In total, 307,377 patients underwent surgical repair of a hip fracture between 2016 and 2021 (Table 1). The total number of patients who were treated for hip fractures each year increased by 5.4% between 2016 and 2021 (2016: 49,570, 2021: 52,233). Of those patients, 258,821 (84.2%) were not depressed and 48,556 (15.8%) were depressed. The average age of the patients without depression was 81.5 ± 7.5, and the average age of the patients with depression was 80.1 ± 7.6 (P < 0.01). Women made up 68.6% of patients without depression compared with 76.3% of patients with depression (P < 0.01). Most of the patients were White (86.1% and 90.5% of patients without depression and with depression, respectively, P < 0.01). Fewer Black and Hispanic patients were observed in the depressed cohort (4.0% Black and 5.6% Hispanic compared with 2.3% Black and 4.4% Hispanic, P < 0.01).
Several differences were observed in comorbidities between patients with and without depression. Patients with depression had lower Elixhauser comorbidity scores (depressed: 5.5, not depressed: 8.3, P < 0.01). Fewer depressed patients were observed with an OFS of 0 (depressed: 14.8%, not depressed: 16.2%, P < 0.01) and more depressed patients with a score of 1 (depressed: 40.5%, not depressed: 38.1%, P < 0.01). Of the 307,377 patients in the study, 129,272 had a point assigned to their frailty score based on age (85 and older). Fewer patients with depression were included in this category than patients without depression (P < 0.01). More depressed patients had congestive heart failure (depressed: 19.5%, not depressed 19.0%, P = 0.01), liver disease (depressed: 2.4%, not depressed: 2.1%, P < 0.01), obesity (depressed: 7.7%, not depressed: 5.4%, P < 0.01), hypertension (depressed: 78.3%, not depressed: 76.5%, P < 0.01), and diabetes (depressed: 25.2%, not depressed: 23.8%, P < 0.01).
Unadjusted Surgical Outcomes
After surgery, outcomes differed between patients with and without depression when comorbidities, age, and demographics were not accounted for (Table 2). Fewer patients with depression died during their hospital admission (depressed: 1.4%, not depressed: 1.7%, P < 0.01). Furthermore, fewer patients with depression experienced myocardial infarction during their hospital stay (depressed: 1.5%, not depressed: 1.8%, P < 0.01). No differences were observed between groups for DVT/PE or infection. Fewer patients with depression experienced a routine discharge (depressed: 13.7%, not depressed: 16.6%, P < 0.01). Patients with depression had a marginally longer length of stay (depressed: 5.54 days, not depressed: 5.49 days, P < 0.01) and fewer total charges than patients without depression (depressed: $79,375, not depressed: $81,285, P < 0.01).
Table 2.
Unadjusted Hip Fracture Surgical Outcomes for Patients With and Without Depression From 2016 to 2021
| Factor or Variable | Not Depressed (N = 100,787) | Depressed (N = 18,976) | P Value |
| Inpatient mortality | <0.01 | ||
| Alive | 254,360 (98.3%) | 47,875 (98.6%) | |
| Died | 4,363 (1.7%) | 659 (1.4%) | |
| DVT or PE | 0.12 | ||
| No DVT or PE | 255,517 (98.7%) | 47,978 (98.8%) | |
| DVT or PE | 3,304 (1.3%) | 578 (1.2%) | |
| Myocardial infarction | <0.01 | ||
| No MI | 254,102 (98.2%) | 47,827 (98.5%) | |
| MI | 4,719 (1.8%) | 729 (1.5%) | |
| Infection | 0.68 | ||
| No infection | 258,457 (99.9%) | 48,484 (99.9%) | |
| Infection | 364 (0.1%) | 72 (0.1%) | |
| Discharge disposition | <0.01 | ||
| Routine | 43,007 (16.6%) | 6,625 (13.7%) | |
| Nonroutine | 215,716 (83.4%) | 41,909 (86.3%) | |
| Length of stay: mean (SD) | 5.49 (4.11) | 5.54 (4.07) | <0.01 |
| Total charge: mean (SD) | $81,285 ($63,780) | $79,375 ($59,147) | <0.01 |
DVT = deep vein thrombosis, PE = pulmonary embolism, MI = myocardial infarction
The bold entries represent statistically significant differences (p<0.05).
Depression and Patient Outcomes
After correcting for age, sex, race, and ECI, depression was a predictor for several patient outcomes after surgical treatment of hip fractures (Table 3). Patients with depression were more likely to experience inpatient mortality (odds ratio [OR], 1.13 to 1.33, P < 0.01), DVT/PE (OR, 1.03 to 1.23, P = 0.01), and myocardial infarction (OR, 1.02 to 1.19, P = 0.02) than patients without depression. Depression did not affect odds of infection. Patients with depression were less likely to experience a routine discharge than patients without depression (OR, 0.62 to 0.66, P < 0.01), and they were more likely to experience a longer length of stay (β coefficient 95% confidence interval [CI] 0.46 to 0.54, P < 0.01) and greater total charges (β coefficient 95% CI, 2,511 to 3,716, P < 0.01).
Table 3.
Depression as a Predictor of Patient Outcomes
| Factor or Variable | Odds Ratio/Beta Coefficienta | 95% Confidence Interval | P Value |
| Inpatient mortality | 1.23 | 1.13-1.33 | <0.01 |
| DVT/PE | 1.12 | 1.03-1.23 | 0.01 |
| Myocardial infarction | 1.10 | 1.02-1.19 | 0.02 |
| Infection | 1.26 | 0.98-1.63 | 0.07 |
| Routine discharge | 0.64 | 0.62-0.66 | <0.01 |
| Length of stay | 0.50a | 0.46-0.54 | <0.01 |
| Total charge | 3,113a | 2,511-3,716 | <0.01 |
Beta coefficients are reported for continuous variables.
DVT = deep vein thrombosis, PE = pulmonary embolism
Odds ratios and beta coefficients for depression as a predictor of patient outcomes after accounting for confounding variables (age, sex, race, Elixhauser Comorbidity Index, congestive heart failure, liver disease, obesity, hypertension, and diabetes).
The bold entries represent statistically significant differences (p<0.05).
Quantification of Comorbidities
The OFS and ECI both significantly predicted each of the outcome variables (Tables 4 and 5). The OFS predicted greater odds of inpatient mortality (OFS, 2.15 to 2.29, P < 0.01; ECI, 1.11 to 1.12, P < 0.01), DVT/PE (OFS, 1.71 to 1.84, P < 0.01; ECI, 1.06 to 1.07, P < 0.01), myocardial infarction (OFS, 2.27 to 2.41, P < 0.01; ECI, 1.08 to 1.09, P < 0.01), and infection (OFS, 1.73 to 2.14, P < 0.01; ECI, 1.06 to 1.08, P < 0.01) than ECI for each additional point. The OFS predicted lower odds of routine discharge than ECI for each additional point (OFS, 0.75 to 0.77, P < 0.01; ECI, 0.96 to 0.97, P < 0.01). The OFS also predicted a greater increase in length of stay (β coefficient 95% CI, OFS, 0.92 to 0.95, P < 0.01; ECI, 0.14 to 0.15, P < 0.01) and total charges (β coefficient 95% CI, OFS, 9,619 to 10,144, P < 0.01; ECI, 1,657 to 1,713, P < 0.01) than ECI for each additional point.
Table 4.
Odds Ratios and Beta Coefficients for Orthopaedic Frailty Score as a Predictor of Patient Outcomes After Accounting for Age, Sex, and Race
| Factor or Variable | Odds Ratio/Beta Coefficienta | 95% Confidence Interval | P Value |
| Inpatient mortality | 2.22 | 2.15-2.29 | <0.01 |
| DVT/PE | 1.77 | 1.71-1.84 | <0.01 |
| Myocardial infarction | 2.34 | 2.27-2.41 | <0.01 |
| Infection | 1.92 | 1.73-2.14 | <0.01 |
| Routine discharge | 0.76 | 0.75-0.77 | <0.01 |
| Length of stay | 0.93a | 0.92-0.95 | <0.01 |
| Total charge | 9,881a | 9,619-10,144 | <0.01 |
Beta coefficients are reported for continuous variables.
DVT = deep vein thrombosis, PE = pulmonary embolism
Table 5.
Odds Ratios and Beta Coefficients for Elixhauser Comorbidity Score as a Predictor of Patient Outcomes After Accounting for Age, Sex, and Race
| Factor or Variable | Odds Ratio/Beta Coefficienta | 95% Confidence Interval | P Value |
| Inpatient mortality | 1.11 | 1.11-1.12 | <0.01 |
| DVT/PE | 1.07 | 1.06-1.07 | <0.01 |
| Myocardial infarction | 1.09 | 1.08-1.09 | <0.01 |
| Infection | 1.07 | 1.06-1.08 | <0.01 |
| Routine discharge | 0.97 | 0.96-0.97 | <0.01 |
| Length of stay | 0.14a | 0.14-0.15 | <0.01 |
| Total charge | 1,685a | 1,657-1,713 | <0.01 |
Beta coefficients are reported for continuous variables.
DVT = deep vein thrombosis, PE = pulmonary embolism
Discussion
The primary finding from this study is that patients with depression are more likely to experience inpatient morbidity and mortality after hip fracture repair than patients without depression. Among patients with hip fractures, women and White individuals are more likely to be depressed, and lower Elixhauser comorbidity scores are associated with depression. The results support our hypothesis that patients with depression have increased odds of inpatient mortality, DVT/PE, and myocardial infarction after hip fracture repair and patients with depression are more likely to experience a nonroutine discharge, a longer length of stay, and greater hospital charges.
This study found that 15.8% of patients were diagnosed with depression. This figure is consistent with previous research demonstrating a prevalence of depression ranging between 9.3% and 28.4% for older adults.7,8 Depression was not specifically screened for in this study, so a lower prevalence is expected. Patients with depression were more likely to be female and White than patients without depression, which supports existing literature that depression is more prevalent among women21 and White individuals.22
Although patients with depression had lower Elixhauser comorbidity scores than patients without depression, they had similar OFSs. Despite the lower Elixhauser comorbidity scores, depressed patients were more likely to be obese and have congestive heart failure, liver disease, hypertension, and diabetes. These findings support previous research demonstrating that obesity and depression are often comorbid and may occur through similar mechanisms,23,24 and patients with more comorbidities have higher prevalence of depression.25,26 This relationship may be due to the emotional burden of disease, social isolation, common risk factors, or a combination of variables. The discrepancy between patients with depression having lower Elixhauser comorbidity indices and greater prevalence of individual comorbidities may be due to the wide variety of conditions included in the index score.
The OFS and ECI both successfully predicted poor postoperative outcomes in hip fracture patients. Each additional point on the OFS predicted a sixfold greater increase in total charges and length of stay than an additional point on the ECI. For each of the other outcome measures (inpatient mortality, DVT/PE, myocardial infarction, infection, and discharge disposition), an additional point in OFS predicted nearly double the odds of adverse events compared with an additional point in ECI. This is likely because the ECI includes 30 comorbidities, whereas the OFS only considers 5, which are measures of frailty and independence. These results lend support to initial findings that the OFS is a sensitive metric to predict poor surgical outcomes in orthopaedic patients, and it has clinical utility because it requires markedly less information to calculate than the ECI.20
Before correcting for confounding factors, patients with depression seemed to have less inpatient mortality, fewer myocardial infarctions, and fewer total charges than patients without depression. However, after correcting for age, sex, race, and comorbidities, patients with depression had less desirable postoperative outcomes. Patients with depression had increased odds of inpatient mortality (OR: 1.23), DVT/PE (OR: 1.12), and myocardial infarction (OR: 1.10); these results align with findings from cardiovascular, bariatric, and spinal surgery suggesting that depression affects postoperative morbidity.9-11,27 A study analyzing total joint arthroplasty postoperative outcomes found that depression was associated with increased risk of PE and infection but lower risk of cardiovascular complications and no association with mortality.28 Although this study found a higher risk of mortality and myocardial infarction in patients with depression, this contradiction could be because patients undergoing elective procedures have fewer risk factors than those with a traumatic injury.28,29 The results of this study are consistent with findings that depressive disorders are associated with increased mortality across surgical specialties.30,31 The increased odds of DVT/PE in this study and the study of total joint arthroplasty may be related to dysregulation of inflammation in patients with depression.28,32 In this study, a difference in infection rates was not identified, but this database only included information from one hospital admission, and infection may not present until after discharge. This is supported by another study of geriatric hip fractures which included information from follow-up visits and found that depression was associated with increased risk of infection, wound complications, and nonunion.33 The association between depressive disorders and infection risk may be mediated by suppression of the immune system.30,34
Length of stay was increased by half a day, total hospital charges were increased by $3,113, and the odds of a routine discharge were approximately two-thirds for patients with depression compared with those without depression. These results are concordant with previous findings that depression is associated with nonroutine discharge after hip fractures and other lower extremity fractures35,36 and that depression is a risk factor for increased length of stay in hospitalized patients.37,38 This could be due to differences in energy, motivation, mood, anxiety, and the availability of social support after surgery, in combination with other factors that may differ in older adults with depression. Depression is also an independent risk factor for postoperative delirium, which would affect discharge planning.30
Taken together, these results lend support to the hypothesis that patients with depression have less desirable outcomes in the immediate postoperative period. Increased odds of inpatient mortality, DVT/PE, and myocardial infarction may be due to the biological effects of depression including alterations in inflammation and the immune system or the psychological effects of depression such as changes in mood, energy, and social support. In addition to impacting rates of acute adverse events, depression may pose a barrier for successful rehabilitation after surgery, which is supported by longer lengths of stay and predisposition to nonroutine discharge.13-15,39 Evidence also suggests that psychological support can improve pain and quality of life after surgery in elderly patients.6 Future work should continue to address whether depression is a modifiable risk factor for patients before surgery.
There are several limitations to this study. The NIS only includes data from a single-hospital admission and does not include data after discharge. Surgical complications including mortality, thrombi or emboli, and infection may not be recognized until after discharge. There is no way to follow patients after their discharge or to monitor for readmission. There is also no way to differentiate between diagnoses that were present on admission as opposed to those which were added during the hospital stay. Some entries were missing data, especially for discharge disposition. The results were not stratified by the method of surgical treatment which is a potential confounding variable, and information regarding interventions such as antidepressant medications and cognitive behavioral therapy was not available. In addition, patients were not uniformly screened for depression, and patients with subsyndromic depression may have been missed. Outpatient diagnoses of depression may not have been included if the patient was seen outside the hospital system or did not elect to disclose their diagnosis, which may lead to underestimation of depression prevalence. Reverse causation is unlikely but possible and is worth monitoring for in future longitudinal studies; future research may also consider stratification by depression severity or chronicity. Finally, the APRDRG_Severity score is a billing-based administrative measure designed for risk-adjusted reimbursement and general severity of illness stratification. It is not validated as a surrogate for physical functional independence or activities of daily living. Its use in this study as a proxy for frailty may misclassify functional status, particularly in older adults who may be functionally impaired without high medical complexity. More direct clinical measures of functional independence, such as prehospital activities of daily living scores or nursing facility status, would provide a more accurate assessment but are not available in the NIS data set. Despite these limitations, the data set allowed for many confounding variables to be accounted for.
Conclusion
In patients with hip fractures, women and White individuals were more likely to be depressed, and lower Elixhauser comorbidity scores were associated with depression. Patients with depression had increased odds of mortality, DVT/PE, and myocardial infarction during their hospitalization. Patients with depression were also more likely to have a nonroutine discharge, a longer length of stay in the hospital, and higher total hospital charges. In addition to experiencing higher rates of adverse events at the time of surgery, patients with depression may face a more difficult recovery after surgery. Based on this data, depression and comorbidity burden may be useful in identifying particularly high-risk subgroups. Screening patients for depression and offering psychological support to patients may improve long-term outcomes after surgery. Future studies should continue to investigate how long-term surgical outcomes are influenced by mental health and if there are any interventions that mitigate these effects.
Footnotes
None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Sullivan, Dr. Ibrahim, Dr. Haglin, Dr. Davies, Dr. Bydon, and Dr. Economopoulos.
Contributor Information
Sufyan Ibrahim, Email: ibrahim.sufyan@mayo.edu.
Jack M. Haglin, Email: haglin.jack@mayo.edu.
Callie M. Davies, Email: davies.callie@mayo.edu.
Mohamad Bydon, Email: bydon.mohamad@mayo.edu.
Kostas J. Economopoulos, Email: economopoulos.kostas@mayo.edu.
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