Department of Surgery, University of Colorado Anschutz, 12636 East 17th Ave, Room 5401, Aurora, CO, 80045, USA.
Surg Endosc. 2023 Mar;37(3):2215-2223. doi: 10.1007/s00464-022-09451-z. Epub 2022 Jul 25.
This study aims to evaluate the impact mental health disorders have on emergency department (ED) utilization following bariatric surgery. We hypothesize that the presence of preexisting psychiatric diagnoses is predictive of increased post-bariatric surgical ED usage as compared to a matched cohort without psychiatric comorbidities.
We utilized the Colorado All Payers Claim Database to identify patients undergoing laparoscopic sleeve gastrectomy, gastric band, or gastric bypass, (N = 5393). Patients with preexisting diagnoses of schizophrenia or bipolar disorder (PSY), and no concomitant mental health diagnosis were included (N = 427). Patients without a psychiatric diagnosis (CON) were used for comparison. Propensity score matching in a 1:1 ratio was done matching for age, sex, BMI, procedure type, and comorbidities. Baseline ED utilization was calculated over the year preceding surgery.
A total of 240 patients with bipolar disorder or schizophrenia were identified. After matching, baseline ED utilization was 62% higher in the PSY group (ED visits per person per month (EDVPP) of 0.17 (95%CI 0.16-0.18) in the PSY group compared to 0.10 (95%CI 0.09-0.12) in the CON group). ED utilization increased dramatically in the month following surgery for both PSY and CON groups (EDVPP 0.58 (95%CI 0.52-0.65) vs 0.34 (95%CI 0.28-0.41)), but visits returned to baseline for the CON but not PSY patients by three months after surgery (11% vs 60% above baseline, respectively). In the PSY group, ED utilization remained elevated at 18% above baseline for two years post-surgery (EDVPP 0.20 (95%CI 0.19-0.22).
Bariatric patients with schizophrenia or bipolar disorder have higher baseline ED usage compared to a matched cohort. ED usage increases post-operatively in all patients but to a greater extent in patients with these diagnoses. Such patients would benefit from intensive outpatient follow-up to limit ED visits.
本研究旨在评估精神健康障碍对减重手术后急诊部（ED）利用的影响。我们假设，与没有合并精神疾病的匹配队列相比，存在先前的精神科诊断预测减重手术后 ED 的使用增加。
我们利用科罗拉多州所有支付者索赔数据库，确定接受腹腔镜袖状胃切除术、胃带或胃旁路术的患者（N=5393）。患有精神分裂症或双相情感障碍（PSY）的患者和没有伴随精神健康诊断的患者（N=427）被纳入研究。没有精神科诊断的患者（CON）用于比较。使用倾向评分匹配进行 1:1 匹配，匹配年龄、性别、BMI、手术类型和合并症。计算手术前一年的基线 ED 利用情况。
共确定了 240 例患有双相情感障碍或精神分裂症的患者。匹配后，PSY 组的基线 ED 利用率高出 62%（PSY 组的 ED 就诊次数/人/月（EDVPP）为 0.17（95%CI 0.16-0.18），而 CON 组为 0.10（95%CI 0.09-0.12））。PSY 和 CON 组在手术后一个月 ED 利用率均显著增加（EDVPP 0.58（95%CI 0.52-0.65）vs 0.34（95%CI 0.28-0.41）），但 CON 组的就诊次数在手术后三个月恢复到基线，而 PSY 组则没有（分别为基线以上增加 11%和 60%）。PSY 组在手术后两年内 ED 利用率仍高出基线 18%（EDVPP 0.20（95%CI 0.19-0.22））。
与匹配队列相比，患有精神分裂症或双相情感障碍的减重患者基线 ED 使用率更高。所有患者术后 ED 利用率均增加，但这些诊断患者增加幅度更大。这些患者将受益于强化门诊随访，以限制 ED 就诊次数。
