Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
Surgery. 2021 Jan;169(1):209-219. doi: 10.1016/j.surg.2020.05.041. Epub 2020 Aug 4.
We examined the effect of psychiatric comorbidities on perioperative surgical outcomes and the leading causes of readmissions in patients who underwent thyroid and parathyroid operations.
Patient information was retrieved from the Nationwide Readmission Database (2010-2017). Multivariate analysis was used to identify predictors for hospital readmissions.
A total of 181,007 and 53,808 patients underwent thyroid and parathyroid operations, respectively. Of those, 8,468 (4.7%) and 6,112 (11.4%) patients were readmitted within 30 days. Psychiatric comorbidities were more frequent in readmitted cohorts after thyroidectomies (14.9% vs 10.4%; P < .001) and parathyroidectomies (16.8% vs 11.5%; P < .001), with anxiety being the most frequent cause (thyroid: 7.87%, parathyroid: 6.8%). Psychiatric comorbidities were associated with greater risk of in-hospital mortality (thyroid: odds ratio = 2.07, 95% confidence interval = 1.13-3.53; P = .015 and parathyroid: odds ratio = 1.67, 95% confidence interval = 1.04-2.70; P = .005), postoperative complications (thyroid: odds ratio = 1.528, 95% confidence interval = 1.473-1.585; P < .001 and parathyroid: odds ratio = 3.26, 95% confidence interval = 2.84-3.73; P < .001), prolonged duration of stay (thyroid: beta coefficient = 1.142, 95% confidence interval = 1.076-1.207; P < .001 and parathyroid: beta coefficient = 2.15, 95% confidence interval = 1.976-2.32; P < .001), and 30-day readmissions (thyroid: hazard ratio = 1.18, 95% confidence interval = 1.03-1.18; P = .047 and parathyroid: hazard ratio = 1.23, 95% confidence interval = 1.11-1.36; P < .001). Psychosis had the greatest risk of readmission (thyroid: hazard ratio = 1.51 and parathyroid: hazard ratio = 1.42), and dementia (odds ratio = 2.58) had the greatest risk of postoperative complications.
Concomitant psychiatric conditions after thyroid and parathyroid operations were associated with increased risk of postoperative complications, prolonged hospital stays, and greater rates of readmissions.
我们研究了精神共病对甲状腺和甲状旁腺手术患者围手术期手术结果和再入院主要原因的影响。
从全国再入院数据库（2010-2017 年）中检索患者信息。采用多变量分析确定再入院的预测因素。
共有 181007 例和 53808 例患者分别接受了甲状腺和甲状旁腺手术。其中，30 天内有 8468 例（4.7%）和 6112 例（11.4%）患者再次入院。甲状腺切除术（14.9%比 10.4%；P<0.001）和甲状旁腺切除术（16.8%比 11.5%；P<0.001）后再入院患者的精神共病更为常见，焦虑症是最常见的原因（甲状腺：7.87%，甲状旁腺：6.8%）。精神共病与住院期间死亡率增加相关（甲状腺：优势比=2.07，95%置信区间=1.13-3.53；P=0.015 和甲状旁腺：优势比=1.67，95%置信区间=1.04-2.70；P=0.005）、术后并发症（甲状腺：优势比=1.528，95%置信区间=1.473-1.585；P<0.001 和甲状旁腺：优势比=3.26，95%置信区间=2.84-3.73；P<0.001）、住院时间延长（甲状腺：β系数=1.142，95%置信区间=1.076-1.207；P<0.001 和甲状旁腺：β系数=2.15，95%置信区间=1.976-2.32；P<0.001）和 30 天内再入院（甲状腺：风险比=1.18，95%置信区间=1.03-1.18；P=0.047 和甲状旁腺：风险比=1.23，95%置信区间=1.11-1.36；P<0.001）相关。精神病的再入院风险最高（甲状腺：风险比=1.51 和甲状旁腺：风险比=1.42），痴呆症（优势比=2.58）的术后并发症风险最高。
甲状腺和甲状旁腺手术后并存的精神疾病与术后并发症、住院时间延长和再入院率增加有关。
