Brown Danielle E, Rosen Claire B, Roberts Sanford E, Moneme Adora, Wirtalla Chris, Kelz Rachel R
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
Ann Surg. 2025 Mar 1;281(3):508-513. doi: 10.1097/SLA.0000000000006302. Epub 2024 Apr 19.
To determine the association between postdischarge mental health care and odds of readmission after emergency general surgery (EGS) hospitalization for patients with serious mental illness (SMI).
A mental health visit (MHV) after medical hospitalization is associated with decreased readmissions for patients with SMI. The impact of a MHV after surgical hospitalization is unknown.
Using Medicare claims, we performed a retrospective cohort study of hospitalized EGS patients with SMI aged above 65.5 (2016-2018). EGS included colorectal, general abdominal, hepatopancreatobiliary, hernia, intestinal obstruction, resuscitation, and upper gastrointestinal conditions. SMI was defined as schizophrenia spectrum, mood, or anxiety disorders. The exposure was MHV within 30 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included emergency department presentation and psychiatric admission. Inverse probability weighting was used to evaluated outcomes.
Of 88,092 analyzed patients, 11,755 (13.3%) had a MHV within 30 days of discharge. 23,696 (26.9%) of patients were managed operatively, 64,395 (73.1%) nonoperatively. After adjustment for potential confounders, patients with a postdischarge MHV had lower odds of acute care readmission than patients without a MHV in both operative (OR=0.60; 95% CI: 0.40-0.90) and nonoperative (OR=0.67; 95% CI: 0.53-0.84) cohorts. There was no association between postdischarge MHV and ED presentation or psychiatric admission in the operative or nonoperative groups.
Postdischarge MHV after EGS hospitalization was associated with decreased odds of readmission for patients with SMI managed operatively and nonoperatively. In older EGS patients with SMI, coordination of MHVs may be a mechanism to reduce readmission disparities.
确定严重精神疾病（SMI）患者在急诊普通外科（EGS）住院出院后接受心理健康护理与再入院几率之间的关联。
内科住院后的心理健康就诊（MHV）与SMI患者再入院率降低相关。外科住院后的MHV影响尚不清楚。
利用医疗保险理赔数据，我们对2016 - 2018年65.5岁以上住院的SMI的EGS患者进行了一项回顾性队列研究。EGS包括结直肠、普通腹部、肝胰胆、疝气、肠梗阻、复苏及上消化道疾病。SMI定义为精神分裂症谱系、心境或焦虑障碍。暴露因素为出院后30天内的MHV。主要结局为30天再入院。次要结局包括急诊就诊和精神科住院。采用逆概率加权法评估结局。
在88092例分析患者中，11755例（13.3%）在出院后30天内进行了MHV。23696例（26.9%）患者接受了手术治疗，64395例（73.1%）未接受手术治疗。在调整潜在混杂因素后，出院后进行MHV的患者在手术队列（OR = 0.60；95% CI：0.40 - 0.90）和非手术队列（OR = 0.67；95% CI：0.53 - 0.84）中急性护理再入院几率均低于未进行MHV的患者。出院后MHV与手术或非手术组的急诊就诊或精神科住院之间无关联。
EGS住院出院后进行MHV与手术和非手术治疗的SMI患者再入院几率降低相关。在老年SMI的EGS患者中，协调MHV可能是减少再入院差异的一种机制。
