Department of Surgery, Wexner Medical Center and James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA.
Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, USA.
Ann Surg Oncol. 2021 Oct;28(11):6525-6534. doi: 10.1245/s10434-021-09838-7. Epub 2021 Mar 21.
BACKGROUND: The impact of depression on utilization of post-discharge care and overall episode of care expenditures remains poorly defined. We sought to define the impact of depression on postoperative outcomes, including discharge disposition, as well as overall expenditures associated with the global episode of surgical care. METHOD: The Medicare 100% Standard Analytic Files were used to identify patients undergoing resection for esophageal, colon, rectal, pancreatic, and liver cancer between 2013 and 2017. The impact of depression on inpatient outcomes, as well as home health care and skilled nursing facilities utilization and expenditures, was analyzed. RESULTS: Among 113,263 patients, 14,618 (12.9%) individuals had depression. Patients with depression were more likely to experience postoperative complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.31-1.42), extended length of stay (LOS) (OR 1.41, 95% CI 1.36-1.47), readmission within 90 days (OR 1.20, 95% CI 1.14-1.25), as well as 90-day mortality (OR 1.35, 95% CI 1.27-1.42) (all p < 0.05). In turn, the proportion of patients who achieved a textbook outcome following cancer surgery was lower among patients with depression (no depression: 53.3% vs. depression: 45.3%; OR 0.70, 95% CI 0.68-0.73). Patients with a preexisting diagnosis of depression had higher odds of additional post-discharge expenditures compared with individuals without a diagnosis of depression (OR 1.42; 95% CI 1.35-1.50); patients with a preexisting diagnosis of depression ($10,500, IQR $3,200-$22,500) had higher median post-discharge expenditures versus patients without depression ($6600, IQR $2100-$17,400) (p < 0.001). On multivariable analysis, after controlling for other factors, depression remained associated with a 19.0% (95% confidence interval [CI] 15.7-22.3%) increase in post-discharge expenditures. CONCLUSIONS: Patients with depression undergoing resection for cancer had worse in-patient outcomes and were less likely to achieve a TO. Patients with depression were more likely to require post-discharge care and had higher post-discharge expenditures.
背景：抑郁症对出院后护理的利用和整体治疗费用的影响仍未得到明确界定。我们旨在确定抑郁症对术后结果的影响，包括出院去向，以及与手术治疗整体相关的总支出。
方法：使用医疗保险 100%标准分析文件，确定 2013 年至 2017 年间接受食管、结肠、直肠、胰腺和肝癌切除术的患者。分析了抑郁症对住院患者结局的影响，以及家庭保健和熟练护理设施的使用和支出。
结果：在 113263 名患者中，有 14618 名（12.9%）患者患有抑郁症。患有抑郁症的患者更有可能出现术后并发症（比值比 [OR] 1.36，95%置信区间 [CI] 1.31-1.42）、延长住院时间（OR 1.41，95% CI 1.36-1.47）、90 天内再入院（OR 1.20，95% CI 1.14-1.25）和 90 天死亡率（OR 1.35，95% CI 1.27-1.42）（均 p<0.05）。反过来，患有抑郁症的患者术后达到癌症手术理想结局的比例较低（无抑郁症：53.3% vs. 抑郁症：45.3%；OR 0.70，95% CI 0.68-0.73）。与没有诊断出抑郁症的患者相比，有预先诊断出的抑郁症的患者在出院后的支出上有更高的几率（OR 1.42；95% CI 1.35-1.50）；有预先诊断出的抑郁症的患者（10500 美元，IQR 3200-22500 美元）的中位数出院后支出高于没有抑郁症的患者（6600 美元，IQR 2100-17400 美元）（p<0.001）。在多变量分析中，在控制了其他因素后，抑郁症与出院后支出增加 19.0%（95%置信区间 [CI] 15.7-22.3%）相关。
结论：接受癌症切除术的抑郁症患者住院结果更差，且不太可能达到理想结局。患有抑郁症的患者更有可能需要出院后护理，并且出院后的支出更高。
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