Background: Depression after cardiac surgery is common and associated with adverse long-term outcomes. Little is known about the longitudinal predictors of postoperative depression, and prior research has been limited by failure to adjust for preoperative depressive symptoms and frailty status. Thus, we sought to investigate whether frailty was an independent risk factor for worsening depressive symptomatology after cardiac surgery. Methods: Our prospectively enrolled cohort consisted of consecutive patients undergoing cardiac surgery at a single-center. Patients were evaluated before and six months after surgery with the 5-item geriatric depression scale (GDS). Additional covariates included: age, sex, type of surgical procedure, comorbidities, cognitive function, social support, activities of daily living, and frailty status according to Fried's scale. Multivariable linear regression was used to identify predictors of longitudinal change in GDS, defined as GDS score at 6 months - GDS score at baseline (with higher values indicating worsening depression). Results: In all, 636 patients were included with a mean age of 72+/-10 years and 31% females. The mean GDS score was 1.0+/-1.2 at baseline and 0.8+/-1.2 at 6 months, with 518 (81%) patients improving or remaining stable and 118 (19%) deteriorating after surgery. Multivariable modeling with baseline covariates showed that frailty was associated with GDS deterioration (beta 0.11, 95% CI 0.02-0.21) whereas baseline GDS was associated with improvement (beta -0.67, range -0.75 to -0.59, p-value <0.001); no other patient- or procedurerelated covariates were significantly predictive. Further modeling showed that the GDS deterioration was mediated by having had postoperative complications, requiring readmissions, and becoming dependent for ADLs. Conclusions: Frail patients are more likely to develop worsening depressive symptomatology after cardiac surgery, which appears to be mediated by a heightened risk of postoperative morbidity and dependency.
S., T., C., H., & J., A. (2016). Impact of frailty on longitudinal change in depressive symptomatology before and after cardiac surgery. Journal of the American College of Cardiology, 67(13), 1988. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L72243491