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Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients

  • 2023 SAGES Oral
  • Published:
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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.

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References

  1. National Institute of Mental Health (2021) Major depression. https://www.nimh.nih.gov/health/statistics/major-depression. Accessed 28 Mar 2023

  2. Srivatsan S, Guduguntla V, Young KZ et al (2021) Clinical versus patient-reported measures of depression in bariatric surgery. Surg Endosc 32:3683–3690. https://doi.org/10.1007/s00464-018-6101-8

    Article  Google Scholar 

  3. Luppino FS, de Wit LM, Bouvy PF et al (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220–229. https://doi.org/10.1001/archgenpsychiatry.2010.2

    Article  Google Scholar 

  4. Mitchell JE, King WC, Chen J-Y et al (2014) Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity (Silver Spring, MD) 22:1799–1806. https://doi.org/10.1002/oby.20738

    Article  PubMed  Google Scholar 

  5. Benalcazar DA, Cascella M (2023) Obesity surgery pre-op assessment and preparation. In: StatPearls. StatPearls Publishing, Treasure Island

    Google Scholar 

  6. Kuruba R, Koche LS, Murr MM (2007) Preoperative assessment and perioperative care of patients undergoing bariatric surgery. Med Clin N Am 91:339–351, ix. https://doi.org/10.1016/j.mcna.2007.01.010

    Article  Google Scholar 

  7. Stierman B, Afful J, Carroll M et al (2021) NHSR 158. National Health and Nutrition Examination Survey 2017–March 2020 pre-pandemic data files. National Center for Health Statistics (US)

    Google Scholar 

  8. American Society for Metabolic and Bariatric Surgery (2021) Metabolic and bariatric surgery fact sheet. https://asmbs.org/resources/metabolic-and-bariatric-surgery. Accessed 28 Mar 2023

  9. Centers for Disease Control and Prevention (2022) Obesity is a common, serious, and costly disease. https://www.cdc.gov/obesity/data/adult.html. Accessed 28 Mar 2023

  10. Maciejewski ML, Arterburn DE, Van Scoyoc L et al (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151:1046–1055. https://doi.org/10.1001/jamasurg.2016.2317

    Article  PubMed  PubMed Central  Google Scholar 

  11. Courcoulas AP, Yanovski SZ, Bonds D et al (2014) Long-term outcomes of bariatric surgery: a National Institutes of Health Symposium. JAMA Surg 149:1323–1329. https://doi.org/10.1001/jamasurg.2014.2440

    Article  PubMed  PubMed Central  Google Scholar 

  12. Eliasen M, Grønkjær M, Skov-Ettrup LS et al (2013) Preoperative alcohol consumption and postoperative complications: a systematic review and meta-analysis. Ann Surg 258:930–942. https://doi.org/10.1097/SLA.0b013e3182988d59

    Article  Google Scholar 

  13. Wood MH, Carlin AM, Ghaferi AA et al (2019) Association of race with bariatric surgery outcomes. JAMA Surg 154:e190029. https://doi.org/10.1001/jamasurg.2019.0029

    Article  PubMed Central  Google Scholar 

  14. Birkmeyer NJO, Dimick JB, Share D et al (2010) Hospital complication rates with bariatric surgery in Michigan. JAMA 304:435–442. https://doi.org/10.1001/jama.2010.1034

    Article  CAS  Google Scholar 

  15. Kroenke K, Strine TW, Spitzer RL et al (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114:163–173. https://doi.org/10.1016/j.jad.2008.06.026

    Article  PubMed  Google Scholar 

  16. Higgins-Biddle JC, Babor TF (2018) A review of the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, and USAUDIT for screening in the United States: past issues and future directions. Am J Drug Alcohol Abuse 44:578–586. https://doi.org/10.1080/00952990.2018.1456545

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hsu LK, Benotti PN, Dwyer J et al (1998) Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med 60:338–346. https://doi.org/10.1097/00006842-199805000-00021

    Article  CAS  PubMed  Google Scholar 

  18. van Hout GCM, Verschure SKM, van Heck GL (2005) Psychosocial predictors of success following bariatric surgery. Obes Surg 15:552–560. https://doi.org/10.1381/0960892053723484

    Article  Google Scholar 

  19. Müller A, Mitchell JE, Sondag C, de Zwaan M (2013) Psychiatric aspects of bariatric surgery. Curr Psychiatry Rep 15:397. https://doi.org/10.1007/s11920-013-0397-9

    Article  PubMed  Google Scholar 

  20. Paredes AZ, Hyer JM, Diaz A et al (2020) The impact of mental illness on postoperative outcomes among Medicare beneficiaries: a missed opportunity to help surgical patients? Ann Surg 272:419–425. https://doi.org/10.1097/SLA.0000000000004118

    Article  PubMed  Google Scholar 

  21. Siddique SM, Tipton K, Leas B (2021) Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Network Open 4:e2125846. https://doi.org/10.1001/jamanetworkopen.2021.25846

  22. Hunt GE, Malhi GS, Lai HMX, Cleary M (2020) Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: systematic review and meta-analysis. J Affect Disord 266:288–304. https://doi.org/10.1016/j.jad.2020.01.141

    Article  PubMed  Google Scholar 

  23. Conner KR, Pinquart M, Gamble SA (2009) Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat 37:127–137. https://doi.org/10.1016/j.jsat.2008.11.007

    Article  PubMed  PubMed Central  Google Scholar 

  24. Haskins IN, Amdur R, Vaziri K (2014) The effect of smoking on bariatric surgical outcomes. Surg Endosc 28:3074–3080. https://doi.org/10.1007/s00464-014-3581-z

    Article  PubMed  Google Scholar 

  25. Janes LA, Hammond JW, Bonham AJ et al (2023) The effect of marijuana use on short term outcomes with bariatric surgery. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2023.02.025

    Article  Google Scholar 

  26. Shin C, Lee S-H, Han K-M et al (2019) Comparison of the usefulness of the PHQ-8 and PHQ-9 for screening for major depressive disorder: analysis of psychiatric outpatient data. Psychiatry Investig 16:300–305. https://doi.org/10.30773/pi.2019.02.01

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The MBSC is funded by Blue Cross Blue Shield of Michigan (BCBSM)/Blue Care Network (BCN).

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Author notes

  1. Erin Kim and Juliana L. Ramirez have contributed equally to this work as co-first authors.

Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Juliana L. Ramirez, Erin Kim, Andrew C. Fregenal, Hannah J. Vigran, Sarah E. Hughes & Christopher W. Reynolds

  2. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    Arthur M. Carlin

  3. Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA

    Oliver A. Varban, Anne P. Ehlers & Jonathan F. Finks

  4. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA

    Oliver A. Varban, Anne P. Ehlers, Aaron J. Bonham & Jonathan F. Finks

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  1. Juliana L. Ramirez
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Correspondence to Erin Kim.

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Disclosures

Oliver A. Varban, Arthur M. Carlin, and Jonathan F. Finks receive salary support from BCBSM/BCN for their leadership roles in the MBSC. Juliana Ramirez, Erin Kim, Andrew C. Fregenal, Hannah J. Vigran, Sarah E. Hughes, Christopher W. Reynolds, Anne P. Ehlers, and Aaron J. Bonham have no conflicts of interest or financial ties to disclose.

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Ramirez, J.L., Kim, E., Fregenal, A.C. et al. Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients. Surg Endosc 37, 9582–9590 (2023). https://doi.org/10.1007/s00464-023-10353-x

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