Early electroconvulsive therapy in patients with bipolar depression: A propensity score-matched analysis using a nationwide inpatient database

OBJECTIVESElectroconvulsive therapy (ECT) is a widely used treatment for bipolar depression; however, evidence of its effectiveness is not sufficient. This study therefore aimed to evaluate whether early ECT is associated with reduced length of hospital stay. METHODSIn this retrospective cohort stud...

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Published in:Journal of affective disorders 2022-09, Vol.312, p.245-251
Main Authors: Yamazaki, Ryuichi, Ohbe, Hiroyuki, Matsuda, Yuki, Kito, Shinsuke, Shigeta, Masahiro, Morita, Kojiro, Matsui, Hiroki, Fushimi, Kiyohide, Yasunaga, Hideo
Format: Article
Language:English
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Summary:OBJECTIVESElectroconvulsive therapy (ECT) is a widely used treatment for bipolar depression; however, evidence of its effectiveness is not sufficient. This study therefore aimed to evaluate whether early ECT is associated with reduced length of hospital stay. METHODSIn this retrospective cohort study using the Japanese Diagnosis Procedure Combination database, we identified patients admitted for bipolar depression between April 2010 and March 2018. The primary outcome was length of hospital stay, and the secondary outcome was clinical outcomes and total hospitalization costs. Propensity score-matched analyses were performed to compare the outcomes between patients who received ECT within 8 days of admission (early ECT group) and those who did not (control group). RESULTSWe identified 5941 eligible patients, comprising 219 in the early ECT group and 5722 in the control group. After 1:4 propensity score matching, patients in the early ECT group had significantly shorter lengths of hospital stay than those in the control group (53 days in the early ECT group and 73 days in the control group; difference: -20.2 days; 95 % confidence interval: -29.2 to -11.2 days). There was no significant difference in total hospitalization costs between the two groups. In-hospital mortality and fatal complications were rare in both groups. The result was similar in the sensitivity analysis using inverse probability of treatment weighting. LIMITATIONSOur study was limited by retrospective design and the possibility of unmeasured confounders. CONCLUSIONSEarly ECT was associated with reduced length of hospital stay without increasing total hospitalization costs in patients with bipolar depression.
ISSN:0165-0327
1573-2517
DOI:10.1016/j.jad.2022.06.060