The Association of Preoperative Depression, and C-Reactive Protein Levels with a Postoperative Length of Stay in Patients Undergoing Coronary Artery Bypass Grafting

Round 1

Reviewer 1 Report

This paper is a study that analyzes the depression underlying CAD patients and its effects on LOS after CABG operation with clinical data on whether it is mediated through acute-phase response factor CRP. 

It may be misunderstood to conduct statistical analysis through a measure of depression through a survey without correcting the factors that have the greatest effect on LOS after actual surgery, such as the patient's age and disease severity, through research design. 

Whether the authors intend to change and re-analysis the design that corrects the age and size of the patient group is the biggest variable that can determine the value of this manuscript.

 

Author Response

Dear Editor

Please find enclosed the in attachment responses to useful comments, criticisms, and suggestions raised by Reviewer no.1.

Dear reviewer,

First of all, thank you very much for your review. We want to apologize in advance if we did not understand some questions and comments well and in the order in which you set them up, we tried to answer.

 

Comments and Suggestions for Authors

This paper is a study that analyzes the depression underlying CAD patients and its effects on LOS after CABG operation with clinical data on whether it is mediated through acute-phase response factor CRP.

 

It may be misunderstood to conduct statistical analysis through a measure of depression through a survey without correcting the factors that have the greatest effect on LOS after actual surgery, such as the patient's age and disease severity, through research design.

 

Whether the authors intend to change and re-analysis the design that corrects the age and size of the patient group is the biggest variable that can determine the value of this manuscript.

 

RESPONSE: We appreciate your comments and suggestions. The patients age and disease severity are indeed the covariates that might relate to the postoperative hospital LOS. As stated in the  section 2.3. Statistical analysis, we have included EuroSCORE-II values as the measure of disease severity in the Model 3 of binary logistic regression. However, to avoid double adjustment, variables such as age, gender, or insulin-dependent diabetes mellitus that are already included in the logistic EuroSCORE-II calculation as a measure of disease severity  that incorporates patient-related (age, gender, chronic pulmonary disease, extracardiac arteriopathy, poor mobility, previous cardiac surgery, active endocarditis, critical preoperative state, renal impairment, diabetes on insulin), cardiac-related [Canadian Cardiovascular Society grading of angina pectoris (CCS angina class 4), left ventricle (LV) function, recent myocardial infarction (MI), pulmonary hypertension, the New York Heart Association (NYHA) Classification score] and operation-related factors (surgery on thoracic aorta, urgency, weight of the operation) were not included in Model 3 of adjusted binary logistic regression.

Author Response File: Author Response.pdf

Reviewer 2 Report

I recommend indicating the year in the in-text citations for example:

rate of preoperative depression among female CABG patients was also reported by Yang 461 et al. and Poole et al.

In my opinion, I think the study report or manuscript has achieved the objectives set out by the authors. It was an excellent study and should be considered for publication so as more persons can get educated about the relationship with pre- and postoperative activities with C-reactive levels.

This study can also help other studies be carried out at other geographical locations to see if there is the effect of possible geographical settings on such report

Author Response

Dear Editor

Please find enclosed in attachment the responses to useful comments, criticisms, and suggestions raised by Reviewer no.2.

Dear reviewer,

First of all, thank you very much for your review. We want to apologize in advance if we did not understand some questions and comments well and in the order in which you set them up, we tried to answer.

 

Comments and Suggestions for Authors

 

I recommend indicating the year in the in-text citations for example:

rate of preoperative depression among female CABG patients was also reported by Yang 461 et al. and Poole et al.

In my opinion, I think the study report or manuscript has achieved the objectives set out by the authors. It was an excellent study and should be considered for publication so as more persons can get educated about the relationship with pre- and postoperative activities with C-reactive levels.

This study can also help other studies be carried out at other geographical locations to see if there is the effect of possible geographical settings on such report

RESPONSE: We are grateful for your comments and suggestions. We have indicated the year in the in-text citations of the revised manuscript.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

In this manuscript, Ivankovic et al investigated the correlation between the preoperative depression and C-reactive protein levels with postoperative length of stay in patients, undergoing coronary artery bypass grafting (CADG). This is an interesting study and the efforts from the authors to improve the patient mental health associated with operative procurers is definitely commendable. In that regard, this is a study that has direct patient relevance. I recommend this study to be published in MDPI-Applied Sciences, provided authors answer the following questions.

1.    The authors didn’t mention anything about gender bias for this association. What is their thought on this? Can they divide their patient population into male and female and predict an effect?

2.    Why did they investigate specifically C-reactive protein levels to correlate between CAD and CABG? This is not clear at all although C-reactive protein is mentioned in the title. This needs to be highlighted in the introduction section. They also need to clarify with relevant references that if C-reactive proteins are also related to any other post-operative procedures associated with diseases, other than CAD.     

3.    Finally, given that they didn’t find any correlation at this point yet, the authors need to highlight the importance of the study in the current context. Otherwise, I don’t see the importance of this study as yet. Hence, it is very important for the authors to specifically mention more about the novelty of this study in the discussion/conclusion section.

Author Response

Dear Editor

Please find enclosed in attachment the responses to useful comments, criticisms, and suggestions raised by Reviewer no.3.

Dear reviewer,

First of all, thank you very much for your review. We want to apologize in advance if we did not understand some questions and comments well and in the order in which you set them up, we tried to answer.

 

 Comments and Suggestions for Authors

In this manuscript, Ivankovic et al investigated the correlation between the preoperative depression and C-reactive protein levels with postoperative length of stay in patients, undergoing coronary artery bypass grafting (CADG). This is an interesting study and the efforts from the authors to improve the patient mental health associated with operative procurers is definitely commendable. In that regard, this is a study that has direct patient relevance. I recommend this study to be published in MDPI-Applied Sciences, provided authors answer the following questions.

 

1. The authors didn’t mention anything about gender bias for this association. What is their thought on this? Can they divide their patient population into male and female and predict an effect?

RESPONSE: We are grateful for your useful comments and suggestions. We have performed the requested analysis in male and female population and results are incorporated in the revised manuscript text (highlighted in red).

2. Why did they investigate specifically C-reactive protein levels to correlate between CAD and CABG? This is not clear at all although C-reactive protein is mentioned in the title. This needs to be highlighted in the introduction section. They also need to clarify with relevant references that if C-reactive proteins are also related to any other post-operative procedures associated with diseases, other than CAD.

RESPONSE: We are grateful for your comments. The corresponding changes are introduced in the revised manuscript text.

3. Finally, given that they didn’t find any correlation at this point yet, the authors need to highlight the importance of the study in the current context. Otherwise, I don’t see the importance of this study as yet. Hence, it is very important for the authors to specifically mention more about the novelty of this study in the discussion/conclusion section.

 

RESPONSE: WE are grateful for your useful suggestions. The revised manuscript text was changed accordingly.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

I am happy with the changes that the authors' incorporated and approve this for publications. Congratulations to the team for an important piece of work.