Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
Surg Endosc. 2019 May;33(5):1661-1666. doi: 10.1007/s00464-018-6459-7. Epub 2018 Sep 25.
The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes.
Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history.
During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4 m/kg. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4 days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure.
Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.
在接受减重手术（BS）的患者中，经良好控制或既往精神科诊断对围手术期结局的影响尚不清楚。本研究的主要目的是确定精神科诊断对住院时间（LOS）、BS 后 30 天再入院率和术后体重减轻结果的影响。
回顾性分析了 2014 年至 2016 年在一家学术机构接受腹腔镜袖状胃切除术（LSG）或 Roux-en-Y 胃旁路术（LRNYGB）的患者。从电子病历中获得基线人口统计学数据和精神病史，包括抑郁、焦虑和/或双相情感障碍（DAB）。比较 DAB 患者与无任何精神病史患者的住院 LOS、30 天再入院率和体重多余百分比（%EBWL）。
在研究期间，共回顾了 354 例患者，其中 78%为女性；60%接受了 LSG。术前平均 BMI 为 48.9±8.4m/kg。主要诊断为重度抑郁症（42%），13%同时患有抑郁和焦虑。30 天再入院率明显高于对照组（10.5%比 3.7%，p=0.02）。两组之间的平均住院 LOS 和长 LOS（≥4 天）的发生率没有差异，但在 LSG 患者中，DAB 患者长 LOS 的发生率有上升趋势（9.2%比 4%，p=0.10）。患有抑郁和焦虑症的患者长 LOS 的发生率更高（23.4%比 9.2%，p<0.005）。虽然 DAB 患者 6 个月时的%EBWL 明显较低（41%比 46%，p=0.004），但 1 年的体重减轻结果没有差异，即使在调整手术程序后也是如此。
基线或既往 DAB 患者的早期再入院率明显较高，且有多重诊断的患者与 LOS≥4 天相关。未来的研究应重点阐明精神科诊断对这些质量指标的影响。
