Luis Garcia, Dan Azagury, Homero Rivas, John Morton. Stanford
Introduction: Patients undergoing bariatric surgery frequently present with various obesity-related psychiatric comorbidities, including depression. Furthermore, previous literature has demonstrated a positive association between depression and cardiovascular disease, and obesity serves as an independent risk factor for cardiovascular disease. However, the relationship between preoperative depression and cardio-metabolic risk factors following bariatric surgery remains unknown.
Methods and Procedures: This retrospective analysis utilized data obtained from patients (n=2,420) who underwent bariatric surgery at a single academic medical center in California. Patients underwent either laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Using medical record data, patients were preoperatively categorized as follows: not depressed, history of depression but not currently on anti-depressive medication, and history of depression and presently taking anti-depressive medication. Patient demographic characteristics were obtained preoperatively. Clinical and biochemical risk factors for cardiovascular disease were evaluated preoperatively and 6 and 12 months following bariatric surgery. ANOVA, Kruskal-Wallis, and Chi-square tests were applied where appropriate.
Results: In this sample, 59% of patients were not depressed, 21% had a history of depression but were not taking anti-depressive medication preoperatively, and 20% had a history of depression and were taking anti-depressive medication preoperatively. At baseline, depressive history was positively associated with female sex (p<.0001), older age (p<.0001), White race (p<.0001), Medicare insurance (p<.0001), previous abdominal surgery (p<.0001), length of stay (p<.0001), requiring an inferior vena cava filter (p=.009), total cholesterol (p<.0001), and triglycerides (p=.003). On average, patients with a history of depression taking anti-depressive medication weighed less than patients with a history of depression not on medication and patients without depression preoperatively (p=.002) and 6 (p=.024) and 12 (p=.004) months after surgery. After six months of follow-up, preoperative depressive history was positively associated with total cholesterol (p=.039), triglycerides (p<.0001), HbA1c (p=.039), and fasting serum concentrations of insulin (p=.017). After 12 months of follow-up, preoperative depressive history was positively associated with higher levels of total cholesterol (p=.013), LDL cholesterol (p=.021), and triglycerides (p=0.016).
Conclusion: A history of depression prior to surgery was associated with higher levels of total cholesterol and triglycerides at baseline and 6 and 12 months postoperatively. After 12 months, preoperative depressive history was also associated with higher levels of LDL cholesterol. This study suggests that, on average, bariatric patients with comorbid depression have worse lipid profiles prior to—and up to one year after—bariatric surgery relative to counterparts without depression.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88616
Program Number: P629
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster