Patients under Psychiatric Medication Undergoing Cardiac Surgery Have a Higher Risk for Adverse Events
20 February 2015
18 September 2015
30 October 2015 (online)
Objective The percentage of patients undergoing cardiac surgery under some sort of psychiatric medication (PM) is not negligible. Thus, this study aimed to evaluate a possible impact of preoperative PM on the outcome after cardiac surgery.
Methods A matched case–control study was conducted by including all patients who underwent myocardial revascularization and/or surgical valve operation in our institution from December 2008 till February 2011 by chart review and institutional quality assurance database (QS) analysis.
Results Out of 1,949 patients included, 184 patients (9%) were identified with PM medication (group A). A control group matched for logistic EuroSCORE II, ejection fraction and age was generated (group C). Patients with PM were in mean significantly longer on the intensive care unit (A: 4.94 days; 95% confidence interval (CI), 3.9–5.9 days vs. C: 3.24 days; CI, 2.84–3.64 days; p = 0.003), had longer mechanical ventilation times (A: 36.70 hours; CI, 19.81–53.59 hours vs. C: 20.14 hours; CI, 14.61–25.68 hours; p = 0.258), and significantly more episodes of respiratory insufficiencies (A: 31 episodes [17%] vs. C: 17 episodes [9%]; p = 0.002). Regression analysis revealed preoperative PM as a significant risk factor for respiratory insufficiency (odds ratio: 1.99, CI: 1.0–3.74; p = 0.04). Chest tube drainage (A: 690 mL, CI: 571–808 mL vs. C: 690 mL; CI: 496–884 mL, p = 0.53) and the total amount of red blood cell transfusion units were similar (A: 1.69 units; CI: 1.21–2.18 units vs. C: 1.50 units; CI: 1.04–1.96 units; p = 0.37). Sternal dehiscence requiring sternal refixation was significantly more frequent in A (12 patients [7%] vs. C: 2 patients [1%]; odds ratio: 6.3, CI: 1.4–28.7; p = 0.01). The 30-day mortality was similar in both groups (A: 6 patients [3%] vs. C: 4 patients [2%]; odds ratio: 1.5; CI: 0.4–5.4; p = 0.5); however, the 100-day mortality was near significantly higher in group A (A: 14 patients (8%) vs. C: 6 patients (3%); odds ratio: 2.4, CI: 0.9–6.5, p = 0.057).
Conclusion Patients with preoperative PM developed complications more frequently compared with a matched control group. The underlying multifactorial mechanisms remain unclear. Patients under PM need to be identified and particular care including optimal pre- and postoperative psychiatric assistance is recommended.
Keywordspsychiatric medication - antidepressant medication - coronary artery bypass graft - aortic valve replacement - outcome
This article was presented at the 42th Annual Meeting of the DGTHG in Freiburg as an oral presentation.
- 1 Wittchen HU, Franz J, Klose M, Ryl L. Depressive Erkrankungen. Gesundheitsberichterstattung des Bundes 2010; 51: 18-24
- 2 Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008. www.cdc.gov/nchs/data/databriefs/db76.pdf
- 3 Hawkes AL, Nowak M, Bidstrup B, Speare R. Outcomes of coronary artery bypass graft surgery. Vasc Health Risk Manag 2006; 2 (4) 477-484
- 4 Paykel ES, Brugha T, Fryers T. Size and burden of depressive disorders in Europe. Eur Neuropsychopharmacol 2005; 15 (4) 411-423
- 5 Xiong GL, Jiang W, Clare R , et al. Prognosis of patients taking selective serotonin reuptake inhibitors before coronary artery bypass grafting. Am J Cardiol 2006; 98 (1) 42-47
- 6 Spindelegger CJ, Papageorgiou K, Grohmann R , et al. Cardiovascular adverse reactions during antidepressant treatment: a drug surveillance report of German-speaking countries between 1993 and 2010. Int J Neuropsychopharmacol 2015; 18 (4) . doi 10.1093/ijnp/pyu080
- 7 Tully PJ, Cardinal T, Bennetts JS, Baker RA. Selective serotonin reuptake inhibitors, venlafaxine and duloxetine are associated with in hospital morbidity but not bleeding or late mortality after coronary artery bypass graft surgery. Heart Lung Circ 2012; 21 (4) 206-214
- 8 Rymaszewska J, Kiejna A. Depression and anxiety after coronary artery bypass grafting [in Polish]. Pol Merkuriusz Lek 2003; 15 (86) 193-195
- 9 Chaudhury S, Sharma S, Pawar AA , et al. Psychological correlates of outcome after coronary artery bypass graft. MJAFI 2006; 62: 220-223
- 10 Stroobant N, Vingerhoets G. Depression, anxiety, and neuropsychological performance in coronary artery bypass graft patients: a follow-up study. Psychosomatics 2008; 49 (4) 326-331
- 11 Rymaszewska J, Kiejna A, Hadryś T. Depression and anxiety in coronary artery bypass grafting patients. Eur Psychiatry 2003; 18 (4) 155-160
- 12 Beresnevaitė M, Benetis R, Taylor GJ, Jurėnienė K, Kinduris Š, Barauskienė V. Depression predicts perioperative outcomes following coronary artery bypass graft surgery. Scand Cardiovasc J 2010; 44 (5) 289-294
- 13 Oxlad M, Stubberfield J, Stuklis R, Edwards J, Wade TD. Psychological risk factors for cardiac-related hospital readmission within 6 months of coronary artery bypass graft surgery. J Psychosom Res 2006; 61 (6) 775-781
- 14 Saur CD, Granger BB, Muhlbaier LH , et al. Depressive symptoms and outcome of coronary artery bypass grafting. Am J Crit Care 2001; 10 (1) 4-10
- 15 Blumenthal JA, Lett HS, Babyak MA , et al; NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003; 362 (9384) 604-609
- 16 Kim DH, Daskalakis C, Whellan DJ , et al. Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting. Am J Cardiol 2009; 103 (10) 1391-1395
- 17 Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease. Systematic review of prospective cohort studies. BMJ 1999; 318 (7196) 1460-1467
- 18 Gehi A, Haas D, Pipkin S, Whooley MA. Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study. Arch Intern Med 2005; 165 (21) 2508-2513