Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
Aesthet Surg J. 2014 Feb;34(2):306-16. doi: 10.1177/1090820X13519100.
Mental health conditions, including psychiatric and substance abuse diagnoses, have been associated with poor postoperative outcomes, but no studies have quantified the relationship to date.
The authors examine the association between mental health conditions and immediate postoperative outcomes as defined by further hospital-based acute care within 30 days of surgery.
California State Ambulatory Surgery, Inpatient, and Emergency Department Databases were used to identify all adult patients undergoing outpatient cosmetic plastic surgery between January 2007 and October 2011. Patients were subgrouped by the presence of mental health or substance abuse conditions. Primary outcome was the need for hospital-based acute care (admission or emergency department visit) within 30 days after surgery. Multivariable logistic regression models compared outcomes between groups.
Of 116,597 patients meeting inclusion criteria, 3.9% and 1.4% had either a psychiatric or substance abuse diagnosis, respectively. Adjusting for medical comorbidities, patients with psychiatric disorders more frequently required hospital-based acute care within 30 days postoperatively than those without mental illness diagnoses (11.1% vs 3.6%; adjusted odds ratio [AOR], 1.78 [95% confidence interval, 1.59-1.99]). This was true both for hospital admissions (3.5% vs 1.1%; AOR, 1.61 [1.32-1.95]) and emergency department visits (8.8% vs 2.7%; AOR, 1.88 [1.66-2.14]). The most common acute diagnoses were surgical in nature, including postoperative infection, hemorrhage, and hematoma; the median hospital admission charge was $35 637. Similar findings were noted among patients with a substance abuse diagnosis.
Mental health conditions are independently associated with the need for more frequent hospital-based acute care following surgery, thus contributing to added costs of care. A patient's mental health should be preoperatively assessed and appropriately addressed before proceeding with any elective procedure.
精神健康状况，包括精神科和药物滥用诊断，与术后不良结果有关，但迄今为止尚无研究量化这种关系。
作者检查了精神健康状况与术后 30 天内进一步医院急性治疗定义的即刻术后结果之间的关系。
使用加利福尼亚州门诊手术、住院和急诊部数据库，确定了 2007 年 1 月至 2011 年 10 月期间所有接受门诊美容整形手术的成年患者。患者根据是否存在心理健康或药物滥用状况进行亚组分组。主要结果是术后 30 天内需要进行医院急性治疗（住院或急诊就诊）。多变量逻辑回归模型比较了各组之间的结果。
符合纳入标准的 116597 例患者中，分别有 3.9%和 1.4%有精神科或药物滥用诊断。调整医疗合并症后，与无精神疾病诊断的患者相比，有精神障碍的患者在术后 30 天内更频繁地需要医院急性治疗（11.1% vs. 3.6%；调整后的优势比[OR]，1.78[95%置信区间，1.59-1.99]）。无论是住院（3.5% vs. 1.1%；OR，1.61[1.32-1.95]）还是急诊就诊（8.8% vs. 2.7%；OR，1.88[1.66-2.14]），情况均如此。最常见的急性诊断是手术性质，包括术后感染、出血和血肿；中位数住院费用为 35637 美元。在有药物滥用诊断的患者中也发现了类似的发现。
精神健康状况与术后更频繁地需要医院急性治疗独立相关，从而增加了医疗费用。在进行任何选择性手术之前，应预先评估患者的心理健康状况并进行适当处理。
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