Study Suggests Depression and Race may Independently Affect Receipt of Some Surgeries
Many studies have looked at the presence and effect of post-operative depression on surgical recovery and outcomes, but few have considered pre-operative psychiatric status. In addition, some reports have noted differences in the receipt of surgical interventions for ethnic minorities. Major depressive disorder (MDD) is the most commonly occurring mental illness in the U.S., affecting up to 17% of the population by age 54. Annually, VA treats 150,000 Veterans with MDD. This study examined race and ethnicity as factors potentially associated with surgeries experienced by Veterans with and without MDD. Using VA administrative data, investigators identified a random sample of 317,072 Veterans and then determined if they’d had any of the following surgeries from FY06 through FY09: coronary artery bypass graft (CABG), vascular operations, hip or knee repairs or replacements, or surgeries on the digestive tract. Among this sample, 18,334 (6%) had surgery. Investigators then determined race/ethnicity (5% Hispanic, 17% African American), gender (5% women), depression status (9% had MDD), and comorbidity burden at the time of surgery (e.g., hypertension, diabetes, stroke, cancer).
Findings show that Veterans with pre-existing MDD were less likely to undergo digestive, hip/knee, vascular, or CABG surgeries than Veterans without MDD (4% vs. 6%). In adjusted analyses, minority Veterans were slightly less likely to receive vascular operations compared to white Veterans, but were more likely to undergo digestive system procedures. The effect of depression was independent of race and ethnicity; thus, depression and race would have an additive but not synergistic effect on the odds of receiving surgery. In addition, a gender effect was noted: women Veterans were more likely to have digestive procedures but were less likely to undergo CABG or vascular operations. Authors note that the lack of information regarding severity of illness makes it difficult to determine whether or not diagnostic differences explain differences in surgery. However, they suggest that future research examine variation in surgical outcomes in pre-operatively depressed patients in order to determine the impact of this apparent disparity.
Copeland L, Zeber J, Pugh M, et al. Ethnicity and race variations in receipt of surgery among Veterans with and without depression. Depression Research and Treatment 2011.
This study was partly funded by HSR&D (IIR 09-335). Authors are part of HSR&D’s Veterans Evidence-Based Research Dissemination and Implementation Center (VERDICT), San Antonio, TX.