Does Mental Distress Predict Cardiac Surgical Outcome?

Abstract

Background Mental distress is suspected to influence the morbidity of cardiac patients. Evaluating mental distress in cardiac patients is rare and the impact on surgical outcome is still not certified.

Methods In 94 cardiac surgical patients, mental distress was assessed by the Patient Health Questionnaire-4 (PHQ-4). We defined length of stay in hospital and on intensive care unit as well as time of mechanical ventilation as outcomes on surgery. Age, physical activity, diabetes, overweight, PHQ-4, and an inflammation marker were tested for their predictive value on outcomes.

Results Reportedly prevalence of generalized anxiety was 16.0% and depression rate was 13.8%. Length of stay in hospital was 13 ± 8 days, time of mechanical ventilation was 10 (0–1,207) hours, and length of stay on intensive care unit was 3 ± 6 days. Length of stay in hospital was significantly predicted by age (p = 0.048), low physical activity (p = 0.029), and high C-reactive protein (CRP; p = 0.031). Furthermore, CRP was the only significant predictor of time of mechanical ventilation and length of stay on intensive care unit.

Conclusion Outcome was not predicted by mental distress. However, inflammation marker CRP was predictive for outcome, potentially caused by higher cardiovascular risk profile. Additionally, depression was referred to be associated with inflammation. Probably, the small sample and the timing of assessment were responsible for the missing relation between mental distress and outcome. We presume a relation with low physical activity and depression. Nevertheless, further randomized studies are needed to pay more attention on patients' distress to intervene preoperatively to improve postoperative outcome.

Keywords

outcomes (include mortality - morbidity) - inflammation - systemic - neurocognitive deficits

Publication History

Received: 23 June 2022

Accepted: 22 August 2022

Article published online:
29 November 2022

• References

• 1 Bauer A, Korten I, Juchem G, Kiesewetter I, Kilger E, Heyn J. EuroScore and IL-6 predict the course in ICU after cardiac surgery. Eur J Med Res 2021; 26 (01) 29
• 2 Blessberger H, Kammler J, Domanovits H. et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev 2018; 3 (03) CD004476
• 3 Mathis MR, Duggal NM, Likosky DS. et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology 2019; 131 (05) 1046-1062
• 4 Buschmann K, Wrobel J, Chaban R. et al. Body mass index (BMI) and its influence on the cardiovascular and operative risk profile in coronary artery bypass grafting patients: impact of inflammation and leptin. Oxid Med Cell Longev 2020; 2020: 5724024
• 5 Allgulander C. Anxiety as a risk factor in cardiovascular disease. Curr Opin Psychiatry 2016; 29 (01) 13-17
• 6 Silverman AL, Herzog AA, Silverman DI. Hearts and minds: stress, anxiety, and depression: unsung risk factors for cardiovascular disease. Cardiol Rev 2019; 27 (04) 202-207
• 7 Reiner IC, Tibubos AN, Werner AM. et al. The association of chronic anxiousness with cardiovascular disease and mortality in the community: results from the Gutenberg Health Study. Sci Rep 2020; 10 (01) 12436
• 8 Jiwanmall M, Jiwanmall SA, Williams A. et al. Preoperative anxiety in adult patients undergoing day care surgery: prevalence and associated factors. Indian J Psychol Med 2020; 42 (01) 87-92
• 9 Ferede YA, Bizuneh YB, Workie MM, Admass BA. “Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section”: a cross-sectional study. Ann Med Surg (Lond) 2022; 74: 103272
• 10 Poole L, Leigh E, Kidd T, Ronaldson A, Jahangiri M, Steptoe A. The combined association of depression and socioeconomic status with length of post-operative hospital stay following coronary artery bypass graft surgery: data from a prospective cohort study. J Psychosom Res 2014; 76 (01) 34-40
• 11 Li XM, Li TT, Cong HL. et al. Impact of depression on prognosis of patients with coronary heart disease undergoing revascularization [in Chinese]. Zhonghua Xin Xue Guan Bing Za Zhi 2012; 40 (02) 99-103 Chinese
• 12 Poole L, Kidd T, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Depression, C-reactive protein and length of post-operative hospital stay in coronary artery bypass graft surgery patients. Brain Behav Immun 2014; 37 (100) 115-121
• 13 Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 2002; 16 (04) 162-171
• 14 Wiltink J, Michal M, Wild PS. et al. Associations between depression and diabetes in the community: do symptom dimensions matter? Results from the Gutenberg Health Study. PLoS One 2014; 9 (08) e105499
• 15 Wiltink J, Michal M, Jünger C. et al. Associations between degree and sub-dimensions of depression and metabolic syndrome (MetS) in the community: results from the Gutenberg Health Study (GHS). BMC Psychiatry 2018; 18 (01) 114
• 16 Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J Geriatr Cardiol 2012; 9 (02) 197-208
• 17 Wicke FS, Krakau L, Löwe B, Beutel ME, Brähler E. Update of the standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord 2022; 312: 310-314
• 18 Kliem S, Mößle T, Klatt T. et al. Psychometric evaluation of an Arabic version of the PHQ-4 based on a representative survey of Syrian refugees [in German]. Psychother Psychosom Med Psychol 2016; 66 (09–10): 385-392
• 19 Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146 (05) 317-325
• 20 Kapoor PM, Magoon R, Rawat R, Mehta Y. Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: “A clinical outcome and biomarker-based study”. Ann Card Anaesth 2016; 19 (04) 638-682
• 21 Ge M, Wang Z, Chen T. et al. Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment. J Thorac Dis 2021; 13 (02) 735-742
• 22 Stähli BE, Tasnady H, Lüscher TF. et al. Early and late mortality in patients undergoing transcatheter aortic valve implantation: comparison of the novel EuroScore II with established risk scores. Cardiology 2013; 126 (01) 15-23
• 23 Orri M, Boleslawski E, Regimbeau JM. et al. Influence of depression on recovery after major noncardiac surgery: a prospective cohort study. Ann Surg 2015; 262 (05) 882-889 , discussion 889–890
• 24 Zemła AJ, Nowicka-Sauer K, Jarmoszewicz K, Wera K, Batkiewicz S, Pietrzykowska M. Measures of preoperative anxiety. Anaesthesiol Intensive Ther 2019; 51 (01) 64-69
• 25 Auer CJ, Laferton JAC, Shedden-Mora MC, Salzmann S, Moosdorf R, Rief W. Optimizing preoperative expectations leads to a shorter length of hospital stay in CABG patients: further results of the randomized controlled PSY-HEART trial. J Psychosom Res 2017; 97: 82-89
• 26 Rief W, Shedden-Mora MC, Laferton JA. et al. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: results of the randomized controlled PSY-HEART trial. BMC Med 2017; 15 (01) 4
• 27 Hawkes AL, Nowak M, Bidstrup B, Speare R. Outcomes of coronary artery bypass graft surgery. Vasc Health Risk Manag 2006; 2 (04) 477-484
• 28 Korbmacher B, Ulbrich S, Dalyanoglu H. et al. Perioperative and long-term development of anxiety and depression in CABG patients. Thorac Cardiovasc Surg 2013; 61 (08) 676-681
• 29 Ernst M, Brähler E, Otten D. et al. Inflammation predicts new onset of depression in men, but not in women within a prospective, representative community cohort. Sci Rep 2021; 11 (01) 2271
• 30 Salzmann S, Euteneuer F, Laferton JAC. et al. IL-8 and CRP moderate the effects of preoperative psychological interventions on postoperative long-term outcomes 6 months after CABG surgery - the randomized controlled PSY-HEART trial. Brain Behav Immun 2021; 91: 202-211