Perioperative Course of Cardiac Surgery Patients Affected by Depressive Disorder: A Matched-Pair Analysis

Objectives: Data of the international literature indicates that the number of cardiac surgery patients affected by depressive disorder approximates between 30% and 40%. Furthermore, it is well known that psychiatric disorders have a deleterious impact on morbidity and mortality within the acute peri-operative period.

Methods: This retrospective observational study analyses 303 consecutive cardiac surgery patients. Patients affected by depressive disorder (group I) and a matched-pair cohort without depressive disorder (group II). Matched-pair criteria were sex, age, BMI, and type of operation. Primary endpoint was the perioperative mortality. Secondary endpoint were the perioperative morbidity (pulmonary-, neuropsychological-, infectious-, complications as well as the rate of rehospitalization and duration of hospital stay). Patientś characteristics, intra-, postoperative data, and the in-hospital follow-up were analyzed.

Results: Of 303 patients, 156 (51%) patients were in group I and 147 (49%) were in group II. There were no significant differences with regard to patient characteristics, comorbidities, and procedure-related variables. The overall perioperative mortality was 10/303 (3.3%). Patients with depressive disorder showed a perioperative mortality rate of 4.5% (7/156) versus patients without depressive disorder showed a perioperative mortality rate of 2.0% (3/147). Table 1 demonstrates the incidence of the perioperative morbidity (pulmonary-, neuropsychological-, infectious-, complications as well as the rate of rehospitalization and duration of hospital stay; Table 1).

Table 1 Incidence of the perioperative morbidity

Morbidity	Group I	Group II	p
Duration of mechanical ventilation [h]	20.5 ± 68.1	9.7 ± 16.1	0.063
Reintubation [%]	2	1.7	0.765
Postoperative delirium > 3 d [%]	9.0	2.7	0.011
Duration of ICU stay [d]	6.3 ± 5.9	3 ± 4.2	0.126
Infectious complications [%] DSWI/SSWI/VSH/VAP/Blood stream	5/1.7/2.6/1	4.3/0.3/1/0.3	0.334
Rehospitalization [%]	6.9	4.3	0.031
Duration of hospital stay [d]	12.2 ± 4.8	14.7 ± 19.5	0.194

Conclusion: This matched-pair study demonstrates statistically significant differences between the patients affected by depressive disorder with regard to the incidence of postoperative delirium > 3 days and the rate of rehospitalization. Further prospective randomized trials concerning the improvement in pre-, and postoperative treatment intervention are mandatory.