Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, T2, SE 171 76, Stockholm, Sweden.
Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
Obes Surg. 2020 Jul;30(7):2511-2518. doi: 10.1007/s11695-020-04483-7.
Gastric bypass (GBP) surgery is considered a safe and effective treatment for obesity. However, there is uncertainty regarding the impact of preexisting psychiatric comorbidity on GBP complications. We have investigated whether a psychiatric diagnosis before GBP surgery is associated with delayed discharge (the odds of being in the 90th percentile of length of stay) and rate of reoperation in a nationwide Swedish cohort.
Patients undergoing GBP surgery during 2008-2012 were identified and followed up through the National Patient Register and the Prescribed Drug Register. Logistic regression models were fitted to the studied outcomes.
Among the 22,539 patients identified, a prior diagnosis of bipolar disorder, schizophrenia, depression, neurotic disorders, ADHD (attention deficit hyperactivity disorder), substance use disorder, eating disorder, personality disorder, or self-harm since 1997 (n = 9480) was found to be associated with delayed discharge after GBP surgery (odds ratio [OR] = 1.47, confidence interval [CI] 1.34-1.62), especially in patients with psychiatric hospitalization exceeding 1 week in the 2 years preceding GBP surgery (OR = 2.06, CI 1.30-3.28), compared with those not hospitalized within psychiatry. Likewise, patients with a prior psychiatric diagnosis were more likely to be reoperated within 30 days (OR = 1.25, CI 1.11-1.41), with twice the likelihood OR 2.23 (CI 1.26-3.92) for patients with psychiatric hospitalization of up to a week in the 2 years preceding GBP surgery, compared with patients who had not been hospitalized within psychiatry.
A psychiatric diagnosis before GBP surgery was associated with delayed discharge and increased likelihood of reoperation within 30 days. Patients with a prior psychiatric diagnosis may, therefore, need additional attention and support.
胃旁路（GBP）手术被认为是治疗肥胖症的一种安全有效的方法。然而，对于术前存在的精神共病对 GBP 并发症的影响仍存在不确定性。我们研究了在一个全国性的瑞典队列中，GBP 手术前的精神诊断是否与延迟出院（即在住院时间第 90 百分位数的概率）和再手术率有关。
确定了在 2008-2012 年间接受 GBP 手术的患者，并通过国家患者登记处和处方药物登记处进行随访。使用逻辑回归模型来拟合研究结果。
在确定的 22539 例患者中，自 1997 年以来（n=9480）诊断为双相障碍、精神分裂症、抑郁症、神经症、注意缺陷多动障碍（ADHD）、物质使用障碍、饮食障碍、人格障碍或自伤的患者，与 GBP 手术后延迟出院有关（比值比 [OR] = 1.47，95%置信区间 [CI] 1.34-1.62），尤其是在 GBP 手术前 2 年内精神科住院时间超过 1 周的患者（OR = 2.06，CI 1.30-3.28），与未住院的患者相比。同样，有先前精神科诊断的患者在 30 天内再次手术的可能性更高（OR = 1.25，CI 1.11-1.41），在 GBP 手术前 2 年内精神科住院时间最长为一周的患者再次手术的可能性是未住院患者的两倍（OR 2.23，CI 1.26-3.92）。
GBP 手术前的精神诊断与延迟出院和 30 天内再次手术的可能性增加有关。因此，有先前精神诊断的患者可能需要额外的关注和支持。
