Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
J Gastrointest Surg. 2011 Oct;15(10):1712-7. doi: 10.1007/s11605-011-1640-5. Epub 2011 Jul 23.
There are little data regarding the impact of depression on outcomes after gastrointestinal surgery. We hypothesize that depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery.
We identified 292,191 patients undergoing colon and rectal surgery using the 2008 Nationwide Inpatient Sample. We used multivariate regression to evaluate the effect of depression on length of stay and discharge disposition.
A preoperative diagnosis of depression was present in 20,039 (6.9%) patients. Mean length of stay for those with depression (10.4 days, 95% confidence interval (CI) 10.04-10.76) was significantly longer than for patients without depression (9.64 days, 95% CI 9.48-9.81). After adjusting for cofounders, depression still predicted an increase in length of stay. Additionally, depressed patients were less likely to resume normal function at discharge, as 40% required either home health or time in a skilled facility following discharge from the acute care hospital.
Among patients undergoing colorectal surgery, depression is associated with a significantly prolonged hospital stay and higher likelihood of requiring skilled nursing assistance after discharge. Further research into the mechanism underlying these differences and potential treatment strategies among depressed patients is warranted.
关于抑郁对胃肠道手术后结局的影响，相关数据较少。我们假设抑郁与结肠和直肠手术后患者的住院时间延长和出院去向改变有关。
我们使用 2008 年全国住院患者样本，确定了 292191 例结肠和直肠手术患者。我们使用多变量回归来评估抑郁对住院时间和出院去向的影响。
术前诊断为抑郁的患者有 20039 例（6.9%）。抑郁患者的平均住院时间（10.4 天，95%置信区间 [CI] 10.04-10.76）明显长于无抑郁患者（9.64 天，95% CI 9.48-9.81）。在调整混杂因素后，抑郁仍然预示着住院时间的延长。此外，抑郁患者出院后恢复正常功能的可能性较低，40%的患者需要家庭健康护理或在急性护理医院出院后在熟练护理设施中停留一段时间。
在接受结直肠手术的患者中，抑郁与住院时间明显延长以及出院后更有可能需要熟练护理辅助有关。需要进一步研究这些差异的潜在机制以及抑郁患者的潜在治疗策略。
