Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully).
Psychiatr Serv. 2021 Apr 1;72(4):391-398. doi: 10.1176/appi.ps.201900559. Epub 2021 Feb 9.
Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients.
This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations.
Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes.
Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.
精神科诊断可能是结直肠癌（CRC）手术结局不良的一个危险因素。作者研究了 CRC 患者精神科诊断和精神健康治疗的益处与手术结局之间的关系。
本项回顾性队列研究纳入了 2000 年至 2014 年期间接受 CRC 手术的患者，在手术前 30 天内记录了精神科诊断和精神健康治疗（无治疗、仅药物治疗、仅心理治疗或药物和心理治疗）的情况。使用多变量广义估计方程评估精神科诊断、精神健康治疗与术后结局（术后并发症、住院时间[LOS]和 90 天再入院率）之间的关系。
在 58961 例接受 CRC 手术的患者中，9029 例（15.3%）有精神科诊断，其中 4601 例（51.0%）在术前接受了精神健康治疗（90.0%为精神科药物治疗、6.7%为心理治疗、3.0%为药物和心理治疗）。与无精神科诊断的患者相比，有精神科诊断的患者术后并发症（优势比[OR]=1.09，95%置信区间[CI]=1.03-1.15）和 90 天再入院（OR=1.11，95% CI=1.06-1.17）的风险更高。与无精神科诊断的患者相比，无精神健康治疗或仅药物治疗的精神科诊断患者术后并发症和 90 天再入院的风险增加了 7%-17%。仅接受药物治疗的患者与无精神科诊断的患者相比，LOS 增加了 4%。仅接受心理治疗的精神科诊断患者和无精神科诊断的患者的术后结局相似。
术前精神科诊断与术后结局不良相关。手术质量改进工作应重点关注识别术前有精神科诊断的患者，并在术前解决这些问题。
