Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
Surg Obes Relat Dis. 2018 Mar;14(3):325-331. doi: 10.1016/j.soard.2017.11.030. Epub 2017 Dec 8.
Mental health disorders are common among bariatric surgery patients. Mental health disorders, particularly depression, have been associated with poorer surgical outcomes, indicating the bariatric surgery patient population warrants special clinical attention.
Our study sought to examine the effect of diagnosed mental health disorders on 30-day readmission for those undergoing bariatric surgery in hospitals across Pennsylvania from 2011 to 2014.
We used Pennsylvania Healthcare Cost Containment Council data to perform this analysis. Inclusion criteria encompassed patients aged>18 years who underwent bariatric surgery at any hospital or freestanding surgical facility in Pennsylvania between 2011 and 2014. Mental health disorders were identified using predetermined International Classification of Disease, Ninth Revision codes. Logistic regression was used to model the risk of 30-day readmission and estimate the effect of mental health disorders on 30-day readmission.
Of the 19,259 patients who underwent bariatric surgery, 40.3% had a diagnosed mental health disorder; 6.51% of all patients were readmitted within 30 days. Patients with a diagnosed mental health disorder had 34% greater odds of readmission (odds ratio = 1.34, 95% confidence interval: 1.19-1.51) relative to patients with no diagnosed mental health disorder. Patients with major depressive disorder/bipolar disorder had 46% greater odds of being readmitted compared with patients with no major depressive disorder/bipolar disorder diagnosis.
Study findings imply the need for risk assessment of patients before postoperative discharge. Given that patients with mental health diagnoses are at increased risk of 30-day readmission after bariatric surgery, they may benefit from additional discharge interventions designed to attenuate potential readmissions.
精神健康障碍在接受减重手术的患者中很常见。精神健康障碍，尤其是抑郁症，与较差的手术结果有关，这表明减重手术患者群体需要特别的临床关注。
我们的研究旨在检查 2011 年至 2014 年期间宾夕法尼亚州医院接受减重手术的患者中，确诊的精神健康障碍对 30 天再入院的影响。
我们使用宾夕法尼亚州医疗保健成本控制委员会的数据进行了这项分析。纳入标准包括年龄>18 岁的患者，他们在 2011 年至 2014 年间在宾夕法尼亚州的任何医院或独立手术设施接受了减重手术。使用预定的国际疾病分类，第九修订版代码来识别精神健康障碍。使用逻辑回归来模拟 30 天再入院的风险，并估计精神健康障碍对 30 天再入院的影响。
在接受减重手术的 19259 名患者中，40.3%有确诊的精神健康障碍；所有患者中有 6.51%在 30 天内再次入院。与没有确诊的精神健康障碍的患者相比，患有确诊的精神健康障碍的患者再入院的可能性高 34%（优势比=1.34，95%置信区间：1.19-1.51）。与没有主要抑郁障碍/双相情感障碍诊断的患者相比，患有主要抑郁障碍/双相情感障碍的患者再入院的可能性高 46%。
研究结果表明，在术后出院前需要对患者进行风险评估。鉴于患有精神健康诊断的患者在接受减重手术后 30 天内再入院的风险增加，他们可能受益于旨在减轻潜在再入院风险的额外出院干预措施。
