Gober Leah, Brown Adam, Bunnell Avianne P, Bunnell Brian E, Ruddy Jean Marie
School of Medicine, Mercer University School of Medicine, Savannah, GA, USA.
Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Cardiol Vasc Res (Wilmington). 2021;5(5):1-6. doi: 10.33425/2639-8486.1122.
Mental health disorders (MHD) are prevalent within surgical patient populations and can be associated with poorer postoperative outcomes, particularly in those with more severe MHD (schizophrenia and bipolar disorder). However, these associations have not been examined in vascular surgery patients. This study investigated patients undergoing lower extremity revascularization, hypothesizing that those with severe MHD would experience worse health and postoperative outcomes.
A retrospective chart review of patients from 2010-2015 with peripheral arterial disease (PAD) requiring revascularization was conducted, with subsequent narrowing to those with concurrent MHD diagnoses, including severe MHD (sMHD) defined as bipolar disorder or schizophrenia and non-severe MHD (nsMHD), defined as anxiety or depression. The primary endpoints were 30-day mortality; Major Adverse Limb Events (MALE) including amputation at the above or below knee level; and Major Adverse Cardiac Events (MACE) including myocardial infarction (MI), congestive heart failure (CHF) exacerbation, and arrhythmia. Secondary endpoints were readmission within 30 days, pulmonary complications, and wound infection. Statistical analyses included Fisher Exact Test and Student's T-test.
Eighteen patients with MHD (sMHD, n=10; nsMHD, n=8) were identified and stratified. Twenty-four limbs were revascularized (sMHD, n=13; nsMHD, n=11). Overall incidence of 30-day mortality, MALE, and MACE were 4.2%, 33.3%, and 50.0%, respectively. Readmission rate, pneumonia, and wound infection occurred in 41.7%, 20.8%, and 16.7% of the population. Stratifying by MHD severity, no significant differences were observed for medical comorbidities, MALE, intervention type (open vs. endovascular), or treatment indication (claudication vs. critical limb ischemia). Patients with sMHD had significantly higher rates of MACE compared to patients with nsMHD (30.8% vs. 18.2%, p<.05). Pneumonia was also more prevalent in this group (38.5% vs. 0.0%, p<.05).
While patients with concurrent diagnoses of MHD and PAD presented with similar comorbidities, comparable disease severity, and were equally treated by open versus endovascular techniques, those with severe MHD suffered significantly elevated rates of cardiopulmonary complications, specifically MACE and pneumonia. Further investigation is warranted to identify opportunities to optimize post-operative care for these complex patients.
心理健康障碍（MHD）在外科手术患者群体中普遍存在，并且可能与较差的术后结果相关，特别是在那些患有更严重MHD（精神分裂症和双相情感障碍）的患者中。然而，这些关联尚未在血管外科手术患者中进行研究。本研究调查了接受下肢血管重建术的患者，假设患有严重MHD的患者会有更差的健康状况和术后结果。
对2010年至2015年患有需要血管重建术的外周动脉疾病（PAD）的患者进行回顾性病历审查，随后缩小范围至同时患有MHD诊断的患者，包括定义为双相情感障碍或精神分裂症的严重MHD（sMHD）和定义为焦虑或抑郁的非严重MHD（nsMHD）。主要终点为30天死亡率；主要不良肢体事件（MALE），包括膝上或膝下截肢；以及主要不良心脏事件（MACE），包括心肌梗死（MI）、充血性心力衰竭（CHF）加重和心律失常。次要终点为30天内再入院、肺部并发症和伤口感染。统计分析包括Fisher精确检验和学生t检验。
识别并分层了18例患有MHD的患者（sMHD，n = 10；nsMHD，n = 8）。24条肢体接受了血管重建术（sMHD，n = 13；nsMHD，n = 11）。30天死亡率、MALE和MACE的总体发生率分别为4.2%、33.3%和50.0%。再入院率、肺炎和伤口感染发生率分别为41.7%、20.8%和16.7%。按MHD严重程度分层，在合并症、MALE、干预类型（开放手术与血管腔内手术）或治疗指征（间歇性跛行与严重肢体缺血）方面未观察到显著差异。与nsMHD患者相比，sMHD患者的MACE发生率显著更高（30.8%对18.2%，p <.05）。该组肺炎也更普遍（38.5%对0.0%，p <.05）。
虽然同时患有MHD和PAD的患者具有相似的合并症、可比的疾病严重程度，并且接受开放手术与血管腔内手术的治疗相同，但患有严重MHD的患者心肺并发症发生率显著升高，特别是MACE和肺炎。有必要进一步研究以确定优化这些复杂患者术后护理的机会。
