Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients
Introduction Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. Methods The Michigan Bariatric Surgery Collaborative is a state...
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| creator | Ramirez, Juliana L. Kim, Erin Fregenal, Andrew C. Vigran, Hannah J. Hughes, Sarah E. Reynolds, Christopher W. Varban, Oliver A. Carlin, Arthur M. Ehlers, Anne P. Bonham, Aaron J. Finks, Jonathan F. |
| description | Introduction
Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use.
Methods
The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0–4), mild (5–9), moderate (10–14), or severe (15–24). We compared 30-day outcomes and substance use between patients with and without depression.
Results
Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p |
| doi_str_mv | 10.1007/s00464-023-10353-x |
| format | Article |
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Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use.
Methods
The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0–4), mild (5–9), moderate (10–14), or severe (15–24). We compared 30-day outcomes and substance use between patients with and without depression.
Results
Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008).
Conclusions
This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
Graphical abstract</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10353-x</identifier><identifier>PMID: 37735218</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2023 SAGES Oral ; Abdominal Surgery ; Alcohol ; Bariatric Surgery - adverse effects ; Depression - epidemiology ; Depression - etiology ; Drug use ; Ethanol ; Gastrectomy - adverse effects ; Gastric Bypass - adverse effects ; Gastroenterology ; Gastrointestinal surgery ; Gynecology ; Health services utilization ; Hepatology ; Humans ; Laparoscopy - adverse effects ; Marijuana ; Medicine ; Medicine & Public Health ; Mental depression ; Narcotics ; Obesity, Morbid - complications ; Obesity, Morbid - epidemiology ; Obesity, Morbid - surgery ; Opiate Alkaloids ; Patient Acceptance of Health Care ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - surgery ; Proctology ; Retrospective Studies ; Risk Factors ; Substance-Related Disorders - complications ; Substance-Related Disorders - epidemiology ; Surgery ; Treatment Outcome ; Weight Loss</subject><ispartof>Surgical endoscopy, 2023-12, Vol.37 (12), p.9582-9590</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-93011e0a88f7c1f6665ad7676a7b12344cfc174c627e0d79b5d44088a9b6755d3</cites><orcidid>0000-0002-7597-2432</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10353-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10353-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37735218$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ramirez, Juliana L.</creatorcontrib><creatorcontrib>Kim, Erin</creatorcontrib><creatorcontrib>Fregenal, Andrew C.</creatorcontrib><creatorcontrib>Vigran, Hannah J.</creatorcontrib><creatorcontrib>Hughes, Sarah E.</creatorcontrib><creatorcontrib>Reynolds, Christopher W.</creatorcontrib><creatorcontrib>Varban, Oliver A.</creatorcontrib><creatorcontrib>Carlin, Arthur M.</creatorcontrib><creatorcontrib>Ehlers, Anne P.</creatorcontrib><creatorcontrib>Bonham, Aaron J.</creatorcontrib><creatorcontrib>Finks, Jonathan F.</creatorcontrib><title>Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Introduction
Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use.
Methods
The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0–4), mild (5–9), moderate (10–14), or severe (15–24). We compared 30-day outcomes and substance use between patients with and without depression.
Results
Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008).
Conclusions
This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
Graphical abstract</description><subject>2023 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Alcohol</subject><subject>Bariatric Surgery - adverse effects</subject><subject>Depression - epidemiology</subject><subject>Depression - etiology</subject><subject>Drug use</subject><subject>Ethanol</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastric Bypass - adverse effects</subject><subject>Gastroenterology</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Health services utilization</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy - adverse effects</subject><subject>Marijuana</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental depression</subject><subject>Narcotics</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - epidemiology</subject><subject>Obesity, Morbid - surgery</subject><subject>Opiate Alkaloids</subject><subject>Patient Acceptance of Health Care</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - surgery</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Substance-Related Disorders - complications</subject><subject>Substance-Related Disorders - epidemiology</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Weight Loss</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1v1DAQhq0KRLeFP8ABWeLCJcVfsZMjaumHVIkLnK2JM-m6ZJPF41Rtfz1udwGpBw4jH-aZd0Z-GHsvxYkUwn0mIYw1lVC6kkLXuro_YCtptKqUks0rthKtFpVyrTlkR0S3ovCtrN-wQ-2crguzYnSG24REcZ44EAeeIv3kA4Q8Jz6Ugv4OEyGflxzmDRZk6nmcQkIg7PkaYczrAAn5kuMYHyE_RcWJd5Ai5BQDpyXdYHrg29LDKdNb9nqAkfDd_j1mP86_fj-9rK6_XVydfrmuglY2V-V4KVFA0wwuyMFaW0PvrLPgOqm0MWEI0plglUPRu7are2NE00DbWVfXvT5mn3a52zT_WpCy30QKOI4w4byQV41tpBJKNQX9-AK9nZc0lesK1ba1VM6JQqkdFdJMlHDw2xQ3kB68FP5Jid8p8UWJf1bi78vQh3300m2w_zvyx0EB9A6g0prKT_3b_Z_Y32XhmAs</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>Ramirez, Juliana L.</creator><creator>Kim, Erin</creator><creator>Fregenal, Andrew C.</creator><creator>Vigran, Hannah J.</creator><creator>Hughes, Sarah E.</creator><creator>Reynolds, Christopher W.</creator><creator>Varban, Oliver A.</creator><creator>Carlin, Arthur M.</creator><creator>Ehlers, Anne P.</creator><creator>Bonham, Aaron J.</creator><creator>Finks, Jonathan F.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7597-2432</orcidid></search><sort><creationdate>20231201</creationdate><title>Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients</title><author>Ramirez, Juliana L. ; Kim, Erin ; Fregenal, Andrew C. ; Vigran, Hannah J. ; Hughes, Sarah E. ; Reynolds, Christopher W. ; Varban, Oliver A. ; Carlin, Arthur M. ; Ehlers, Anne P. ; Bonham, Aaron J. ; Finks, Jonathan F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-93011e0a88f7c1f6665ad7676a7b12344cfc174c627e0d79b5d44088a9b6755d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>2023 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Alcohol</topic><topic>Bariatric Surgery - adverse effects</topic><topic>Depression - epidemiology</topic><topic>Depression - etiology</topic><topic>Drug use</topic><topic>Ethanol</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastric Bypass - adverse effects</topic><topic>Gastroenterology</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Health services utilization</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy - adverse effects</topic><topic>Marijuana</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental depression</topic><topic>Narcotics</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - epidemiology</topic><topic>Obesity, Morbid - surgery</topic><topic>Opiate Alkaloids</topic><topic>Patient Acceptance of Health Care</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - surgery</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Substance-Related Disorders - complications</topic><topic>Substance-Related Disorders - epidemiology</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ramirez, Juliana L.</creatorcontrib><creatorcontrib>Kim, Erin</creatorcontrib><creatorcontrib>Fregenal, Andrew C.</creatorcontrib><creatorcontrib>Vigran, Hannah J.</creatorcontrib><creatorcontrib>Hughes, Sarah E.</creatorcontrib><creatorcontrib>Reynolds, Christopher W.</creatorcontrib><creatorcontrib>Varban, Oliver A.</creatorcontrib><creatorcontrib>Carlin, Arthur M.</creatorcontrib><creatorcontrib>Ehlers, Anne P.</creatorcontrib><creatorcontrib>Bonham, Aaron J.</creatorcontrib><creatorcontrib>Finks, Jonathan F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ramirez, Juliana L.</au><au>Kim, Erin</au><au>Fregenal, Andrew C.</au><au>Vigran, Hannah J.</au><au>Hughes, Sarah E.</au><au>Reynolds, Christopher W.</au><au>Varban, Oliver A.</au><au>Carlin, Arthur M.</au><au>Ehlers, Anne P.</au><au>Bonham, Aaron J.</au><au>Finks, Jonathan F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-12-01</date><risdate>2023</risdate><volume>37</volume><issue>12</issue><spage>9582</spage><epage>9590</epage><pages>9582-9590</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Introduction
Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use.
Methods
The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0–4), mild (5–9), moderate (10–14), or severe (15–24). We compared 30-day outcomes and substance use between patients with and without depression.
Results
Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008).
Conclusions
This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
Graphical abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37735218</pmid><doi>10.1007/s00464-023-10353-x</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7597-2432</orcidid></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | 2023 SAGES Oral Abdominal Surgery Alcohol Bariatric Surgery - adverse effects Depression - epidemiology Depression - etiology Drug use Ethanol Gastrectomy - adverse effects Gastric Bypass - adverse effects Gastroenterology Gastrointestinal surgery Gynecology Health services utilization Hepatology Humans Laparoscopy - adverse effects Marijuana Medicine Medicine & Public Health Mental depression Narcotics Obesity, Morbid - complications Obesity, Morbid - epidemiology Obesity, Morbid - surgery Opiate Alkaloids Patient Acceptance of Health Care Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - surgery Proctology Retrospective Studies Risk Factors Substance-Related Disorders - complications Substance-Related Disorders - epidemiology Surgery Treatment Outcome Weight Loss |
| title | Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients |
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