Previous research has established that among patients with peripheral arterial disease (PAD), there is an elevated incidence of MDD. Moreover, among patients with PAD who also have MDD, there is an increased risk of lower extremity amputation (LEA) compared with PAD patients without MDD.

In a recent publication in PRS Global Open, researchers sought to evaluate the symptomatology associated with MDD in patients with PAD after undergoing an LEA.

The authors wrote, “In the general population, it is established that LEA preserves physical health but decreases quality of life and may increase symptoms of MDD. It is unclear which direction LEA influences mental health in complex plastic reconstructive surgery patients.”

Researchers conducted a retrospective chart review of patients from January 2018 to July 2022 involving a single institution wound center with PAD, a diagnosis confirmed by multiple chart documentation, who received LEA from a senior author (C.E.A.).

All patients with a patient health questionnaire (PHQ) or Hamilton Depression Rating Scale (HAM-D) were included. In the MDD cohort, a PHQ score ≥4 and subsequent HAM-D ≥8 prior to the date of amputation were included, and HAM-D scores within 3 months before and after the LEA date were gathered. Paired t-tests were employed for assessment through STATA VSN 7.0 with a significant level set at 0.05.

The results revealed that out of 305 patients with PAD who underwent LEA, 92 (30.6%) were diagnosed with MDD prior to amputation. Patient characteristics included an average age of 58.81 + 10.81 years and BMI of 30.64 + 7.68 kg/m2; 31 (33.69%) were females; 42 (45.65%) had a history of smoking; 56 (60.86%) were diagnosed with type II diabetes; and 39 (42.41%) had peripheral neuropathy. Additionally, prior to the LEA, these patients had an average of 2.23 + 2.39 invasive vascular interventions (stent placement, balloon angioplasty, or open bypass), and of these patients with MDD, HAM-D scores significantly diminished after LEA threefold (12.88 + 4.19 vs. 4.12 + 5.76, P = .0001).

The authors indicated that psychiatric well-being in reconstructive surgery patients is not well-investigated, but having more insight is critical to improving patient care and outcomes. They also noted that this study discovered that among patients with PAD, there is an elevated incidence of MDD.

Based on their findings, the authors wrote, “Our cohort of MDD patients reported decreased depressive symptoms after LEA. Future studies will explore whether a history of MDD influences post-LEA coping and resilience in vulnerable plastic reconstructive surgery patients.”

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