严重精神疾病患者的手术结果不如其他患者：系统评价和荟萃分析。
Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta-analysis.
机构信息
Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW.
Sydney Medical School, University of Sydney, Sydney, NSW.
出版信息
Med J Aust. 2021 May;214(8):379-385. doi: 10.5694/mja2.51009. Epub 2021 Apr 12.
OBJECTIVE
To assess the association between having a serious mental illness and surgical outcomes for adults, including in-hospital and 30-day mortality, post-operative complications, and hospital length of stay.
STUDY DESIGN
Systematic review and meta-analysis of publications in English to 30 July 2018 of studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery. Primary outcomes were in-hospital and 30-day mortality, post-operative complications, and length of hospital stay. Risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. Studies were grouped by serious mental illness diagnosis and outcome measures. Odds ratios (ORs) or mean differences (MDs), with 95% confidence intervals (CIs), were calculated in random effects models to provide pooled effect estimates.
DATA SOURCES
MEDLINE, EMBASE, PsychINFO, and the Cochrane Library.
DATA SYNTHESIS
Of the 3824 publications identified by our search, 26 (including 6 129 806 unique patients) were included in our analysis. The associations between having any serious mental illness diagnosis and having any post-operative complication (ten studies, 125 624 patients; pooled effect: OR, 1.44; 95% CI, 1.15-1.79) and a longer stay in hospital (ten studies, 5 385 970 patients; MD, 2.6 days; 95% CI, 0.8-4.4 days) were statistically significant, but not those for in-hospital mortality (three studies, 42 926 patients; OR, 1.21; 95% CI, 0.69-2.12) or 30-day mortality (six studies, 83 013 patients; OR, 1.85; 95% CI, 0.86-3.99).
CONCLUSIONS
Having a serious mental illness is associated with higher rates of post-operative complications and longer stays in hospital, but not with higher in-hospital or 30-day mortality. Targeted pre-operative interventions may improve surgical outcomes for these vulnerable patients.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42018080114 (prospective).
目的
评估严重精神疾病与成年人手术结果之间的关联，包括院内和 30 天死亡率、术后并发症和住院时间。
研究设计
对 2018 年 7 月 30 日之前以英文发表的研究进行系统评价和荟萃分析，这些研究检查了成年人接受择期手术时严重精神疾病与手术结果之间的关联。主要结果是院内和 30 天死亡率、术后并发症和住院时间。使用预后研究质量（QUIPS）工具评估偏倚风险。根据严重精神疾病诊断和结果测量指标对研究进行分组。使用随机效应模型计算比值比（OR）或均数差（MD）及其 95%置信区间（CI），以提供汇总效应估计。
数据来源
MEDLINE、EMBASE、PsychINFO 和 Cochrane 图书馆。
数据综合
通过我们的搜索共确定了 3824 篇文献，其中 26 篇（包括 6129806 名独特患者）纳入了我们的分析。患有任何严重精神疾病诊断与任何术后并发症（10 项研究，125624 名患者；汇总效应：OR，1.44；95%CI，1.15-1.79）和住院时间延长（10 项研究，5385970 名患者；MD，2.6 天；95%CI，0.8-4.4 天）之间存在统计学显著关联，但与院内死亡率（3 项研究，42926 名患者；OR，1.21；95%CI，0.69-2.12）或 30 天死亡率（6 项研究，83013 名患者；OR，1.85；95%CI，0.86-3.99）无关。
结论
患有严重精神疾病与术后并发症发生率更高和住院时间延长相关，但与院内或 30 天死亡率升高无关。针对这些脆弱患者的术前干预措施可能会改善手术结果。
系统评价注册
PROSPERO，CRD42018080114（前瞻性）。
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