Department of Breast and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Br J Surg. 2021 Mar 12;108(2):168-173. doi: 10.1093/bjs/znaa070.
Although patients with schizophrenia have a higher risk of developing breast cancer than the general population, studies that have investigated postoperative complications after breast cancer surgery in patients with schizophrenia are scarce. This study examined associations between schizophrenia and short-term outcomes following breast cancer surgery.
Patients who underwent surgery for stage 0-III breast cancer between July 2010 and March 2017 were identified from a Japanese nationwide inpatient database. Multivariable analyses were conducted to compare postoperative complications and hospitalization costs between patients with schizophrenia and those without any psychiatric disorder. Three sensitivity analyses were performed: a 1 : 4 matched-pair cohort analysis with matching for age, institution, and fiscal year at admission; analyses excluding patients with schizophrenia who were not taking antipsychotic medication; and analyses excluding patients with schizophrenia who were admitted to hospital involuntarily.
The study included 3660 patients with schizophrenia and 350 860 without any psychiatric disorder. Patients with schizophrenia had a higher in-hospital morbidity (odds ratio (OR) 1.37, 95 per cent c.i. 1.21 to 1.55), with more postoperative bleeding (OR 1.34, 1.05 to 1.71) surgical-site infections (OR 1.22, 1.04 to 1.43), and sepsis (OR 1.20, 1.03 to 1.41). The total cost of hospitalization (coefficient €743, 95 per cent c.i. 680 to 806) was higher than that for patients without any psychiatric disorder. All sensitivity analyses showed similar results to the main analyses.
Although causal inferences remain premature, multivariable regression analyses showed that schizophrenia was associated with greater in-hospital morbidity and higher total cost of hospitalization after breast cancer surgery than in the general population.
尽管精神分裂症患者罹患乳腺癌的风险高于一般人群，但针对精神分裂症患者乳腺癌手术后并发症的研究却很少。本研究旨在探讨精神分裂症与乳腺癌手术后短期结局之间的关系。
本研究从日本全国住院患者数据库中确定了 2010 年 7 月至 2017 年 3 月期间接受 0-III 期乳腺癌手术的患者。采用多变量分析比较了精神分裂症患者与无任何精神障碍患者的术后并发症和住院费用。进行了三项敏感性分析：1：4 配对病例对照队列分析，匹配年龄、机构和入院财政年度；排除未服用抗精神病药物的精神分裂症患者的分析；以及排除非自愿住院的精神分裂症患者的分析。
本研究纳入了 3660 例精神分裂症患者和 350860 例无任何精神障碍患者。精神分裂症患者的院内发病率更高（优势比（OR）1.37，95%置信区间（CI）为 1.21 至 1.55），术后出血（OR 1.34，95%CI 为 1.05 至 1.71）、手术部位感染（OR 1.22，95%CI 为 1.04 至 1.43）和败血症（OR 1.20，95%CI 为 1.03 至 1.41）的发生率更高。总住院费用（系数€743，95%CI 为 680 至 806）高于无任何精神障碍患者。所有敏感性分析结果与主要分析结果相似。
尽管因果关系仍有待证实，但多变量回归分析表明，与一般人群相比，精神分裂症与乳腺癌手术后院内发病率更高和总住院费用更高相关。
