Postoperative But Not Preoperative Depression Is Associated With Cognitive Impairment After Cardiac Surgery

CABG coronary artery bypass graft surgery, AVR aortic valve replacement, MVR mitral valve repair or replacement, TVR tricuspid valve replacement;
^aMissing excluded from summaries and denominators (age [n = 1], sex [n = 1]; race [n = 1]; diabetes [n = 3]; prior stroke [n = 12]; prior myocardial infarction [n = 2]; atrial fibrillation [n = 1]; chronic obstructive pulmonary disease [n = 9]; current tobacco use [n = 4]; years of attained education [n = 44]; minutes of cardiopulmonary bypass [n = 2]; impaired cerebral autoregulation [n = 7]; MAP [n = 5]; area under the curve [n = 5]);
^bP-value from complete cases analysis via fisher's exact for categorical variables, t-tests for normal continuous variables, and Wilcoxon rank sum tests for non-normal continuous variables

^aFalse discovery rate correction for multiple testing applied
^bRegression coefficient interpreted as adjusted mean difference in change in cognitive domain Z-score between Preoperative Depression and No Preoperative Depression groups

^aFalse discovery rate correction for multiple testing applied
^bRegression coefficient interpreted as adjusted mean difference in cognitive domain Z-score between Preoperative Depression and No Preoperative Depression groups

^aFor continuous outcomes, estimate is the linear regression coefficient for depression; for dichotomized outcomes, estimate is the log odds coefficient for depression;
^b P-value from multivariable linear regression model adjusting for age, sex, education, baseline score, treatment arm, diabetes, obesity, prior stroke, hypertension, atrial fibrillation, and COPD;
^c P-value from logistic regression model, with outcome dichotomized at 0, adjusting for baseline score and treatment arm only due to small cell counts;
^d P-value from logistic regression model, with outcome dichotomized at 0, adjusting for age, sex, education, baseline score, treatment arm, diabetes, obesity, prior stroke, hypertension, atrial fibrillation, and COPD
^eFalse discovery rate correction for multiple testing applied

Authors and Disclosures

Choy Lewis¹, Mehmet E. Dokucu², Charles H. Brown³, Lauren Balmert⁴, Nina Srdanovic⁴, Ashwin Shaan Madhan⁵, Sahej Singh Samra⁵, John Csernansky², Jordan Grafman⁶ and Charles W. Hogue¹*

¹Department of Anesthesiology, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 251 East Huron St, Feinberg 5–704, Chicago, IL 60611, USA. ²Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. ³Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. ⁴Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. ⁵Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. ⁶Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA.

*Correspondence
charles.hogue@nm.org

Authors' contributions
Choy Lewis, MD: Analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Mehmet E. Dokucu, ²MD: Analysis and interpretation of the data, revising the manuscript, final approval of the manuscript; agreement with accountability of all aspects of the work. Lauren C. Balmert. PhD: Analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Nina Srdanovic, MS: Analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Ashwin Shaan Madhan, BS: Analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Sahej Singh Samra, BS: Acquisition of the data; analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. John Csernansky, MD: Acquisition of the data; analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Jordan Grafman, PhD: Acquisition of the data; analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Charles H. Brown, IV, MD, MPH: Acquisition of the data; analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. Charles W. Hogue, MD, FAHA: Study design, acquisition of the data; analysis and interpretation of the data; revising the manuscript; final approval of the manuscript; agreement with accountability of all aspects of the work. All authors read and approved the final manuscript.

Authors' information
Not applicable.

Competing interests
Choy Lewis: none.
Mehmet E. Dokucu: none.
Lauren Balmert: none.
Nina Srdanovic: none.
Ashwin Shaan Madhan: None.
Shaej Singh Samra: None.
Jordan Grafman: None.
Dr. Hogue served on the advisory board for Edwards Lifescience, Irvine, CA and serves on a data monitoring committee for Merk, Inc, Kenilworth, NJ.
Charles H. Brown, MD: Consulted and participated with data sharing with Medtronic, Inc.
John Csernansky, MD: Services on a Data Safety and Monitoring Committee for Sunovion Pharmaceuticals.