Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Department of Surgery, New York University Grossman School of Medicine, New York, New York.
J Surg Res. 2023 Nov;291:611-619. doi: 10.1016/j.jss.2023.06.038. Epub 2023 Aug 3.
Bowel obstruction is one of the most common surgical emergencies. The management of SBO is variable and influenced by numerous confounding factors. Recent studies have identified mental health as a health disparity that affects surgical outcomes. We aim to assess whether mental illness is a health disparity and its association with postoperative complications and secondary outcomes for bowel obstruction in Emergency General Surgery (EGS).
This was a retrospective study utilizing the National Inpatient Sample. Individuals aged 18-64 who underwent emergency adehesiolysis or bowel resection from 2015 to 2017 were identified. Postoperative complications, in-hospital mortality, length of stay, and total cost for surgical patients with and without mental illness were recorded. Univariate and multivariate analyses were used to evaluate the association between mental health and bowel obstruction.
20,574 patients who underwent surgery for bowel obstruction were identified. 3756 of these patients had mental illness and 16,998 patients did not. Patients with mental illness did not have significantly worse outcomes compared to patients without mental illness. Among 3576 patients with mental illness, sex, race, patient location, insurance, location/teaching status of hospital, hospital control and procedure type were significant predictors of prolonged length of stay, higher cost, and increased postoperative complications.
Mental health does not appear to be a health disparity in outcomes for bowel obstruction procedures. However, the intersection of mental health with race and insurance status predicts worse outcomes. This essential area should be further explored to determine how marginalized populations are affected in emergency surgical care.
肠梗阻是最常见的外科急症之一。SBO 的治疗方法多种多样，受到许多混杂因素的影响。最近的研究表明，心理健康是影响手术结果的健康差异因素之一。我们旨在评估精神疾病是否是一种健康差异，以及它与急诊普通外科（EGS）中肠梗阻的术后并发症和次要结果的关系。
这是一项回顾性研究，利用国家住院样本。确定了 2015 年至 2017 年间接受急诊粘连松解术或肠切除术的年龄在 18-64 岁的个体。记录有和没有精神疾病的手术患者的术后并发症、住院死亡率、住院时间和总费用。使用单变量和多变量分析评估心理健康与肠梗阻之间的关系。
确定了 20574 名接受肠梗阻手术的患者。其中 3756 名患者患有精神疾病，16998 名患者没有。与没有精神疾病的患者相比，患有精神疾病的患者的结局并没有明显恶化。在 3576 名患有精神疾病的患者中，性别、种族、患者位置、保险、医院位置/教学状态、医院控制和手术类型是延长住院时间、增加成本和增加术后并发症的显著预测因素。
心理健康似乎不是肠梗阻手术结果的健康差异因素。然而，心理健康与种族和保险状况的交叉点预测了更差的结果。这个重要领域应该进一步探讨，以确定边缘人群在急诊外科护理中的影响。
