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精神疾病共病对外科手术死亡率的影响。

Influence of psychiatric comorbidity on surgical mortality.

作者信息

Abrams Thad E, Vaughan-Sarrazin Mary, Rosenthal Gary E

机构信息

Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, IA 52246-2208, USA.

出版信息

Arch Surg. 2010 Oct;145(10):947-53. doi: 10.1001/archsurg.2010.190.

Abstract

OBJECTIVE

To examine the potential effect of 5 existing psychiatric comorbidities on postsurgical mortality.

DESIGN

Retrospective cohort.

SETTING

Intensive care units of all Veterans Health Administration hospitals designated as providing acute care.

PATIENTS

We studied 35 539 surgical patients admitted to intensive care units from October 1, 2003, through September 30, 2006.

MAIN OUTCOME MEASURES

Psychiatric comorbidity (depression, anxiety, posttraumatic stress disorder, bipolar disease, and schizophrenia) was identified using outpatient encounters in the 12 months preceding the index admission. End points included in-hospital and 30-day mortality. Generalized estimating equations accounted for hospital clustering and adjusted mortality for demographics, type of surgery, medical comorbidity, and disease severity.

RESULTS

We identified 8922 patients (25.1%) with an existing psychiatric comorbidity on admission. Unadjusted 30-day mortality rates were similar among patients with and without psychiatric comorbidity (3.8% vs 4.0%, P = .56). After adjustment, 30-day mortality was higher for patients with psychiatric comorbidity (odds ratio, 1.21; 95% confidence interval, 1.07-1.37; P = .003). In individual analyses, patients with depression and anxiety had higher odds of 30-day mortality (P = .01 and P = .02, respectively) but the odds were similar for the other conditions.

CONCLUSION

Existing psychiatric comorbidity was associated with a modest increased risk of death among postsurgical patients. Estimates of the increased risk across the individual conditions were highest for anxiety and depression. The higher mortality may reflect higher unmeasured severity or unique management issues in patients with psychiatric comorbidity.

摘要

目的

研究5种现存精神疾病共病对术后死亡率的潜在影响。

设计

回顾性队列研究。

地点

所有被指定提供急性护理的退伍军人健康管理局医院的重症监护病房。

患者

我们研究了2003年10月1日至2006年9月30日期间入住重症监护病房的35539例外科手术患者。

主要观察指标

使用入院前12个月的门诊就诊情况确定精神疾病共病(抑郁症、焦虑症、创伤后应激障碍、双相情感障碍和精神分裂症)。终点指标包括住院期间和30天死亡率。广义估计方程考虑了医院聚类情况,并针对人口统计学、手术类型、内科疾病共病和疾病严重程度对死亡率进行了调整。

结果

我们确定了8922例(25.1%)入院时存在精神疾病共病的患者。有和没有精神疾病共病的患者未调整的30天死亡率相似(3.8%对4.0%,P = 0.56)。调整后,有精神疾病共病的患者30天死亡率更高(优势比,1.21;95%置信区间,1.07 - 1.37;P = 0.003)。在个体分析中,患有抑郁症和焦虑症的患者30天死亡几率更高(分别为P = 0.01和P = 0.02),但其他情况的几率相似。

结论

现存精神疾病共病与术后患者死亡风险适度增加相关。在个体疾病中,焦虑症和抑郁症的风险增加估计最高。较高的死亡率可能反映了精神疾病共病患者中更高的未测量严重程度或独特的管理问题。

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