健康的社会决定因素和社会支持对接受子宫切除术患者手术结局的影响。
Effects of Social Determinants of Health and Social Support on Surgical Outcomes Among Patients Undergoing Hysterectomy.
作者信息
Hare Adam M, Tappy Erryn, Schaffer Joseph I, Kossl Kelsey, Gaigbe-Togbe Bertille, Kapadia Anjani, Dieter Alexis A, Hamner Jennifer, Laporte Amanda K, Mou Tsung, Mueller Margaret G, Doo Josephine, Park Amy J, Chapman Graham C, Northington Gina, Shockley Marie, Iglesia Cheryl B, Heit Michael
机构信息
Departments of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, University of Texas Southwestern Medical Center, Dallas, Texas, Mount Sinai Hospital, New York, New York, MedStar Washington Hospital Center, Washington, DC, Indiana University, Indianapolis, Indiana, and Emory University School of Medicine, Atlanta, Georgia; the Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and the Obstetrics & Gynecology Institute, Cleveland Clinic, Cleveland, Ohio.
出版信息
Obstet Gynecol. 2025 Jan 1;145(1):115-123. doi: 10.1097/AOG.0000000000005771. Epub 2024 Oct 31.
OBJECTIVE
To describe composite 30-day postoperative complication rates among patients undergoing hysterectomy during the coronavirus disease 2019 (COVID-19) pandemic and to determine baseline and postoperative mental health symptoms, levels of social support, and socioeconomic status and their association with hysterectomy outcomes.
METHODS
This multicenter prospective cohort study at eight centers across the United States enrolled patients who underwent minimally invasive hysterectomy for benign indications during the COVID-19 pandemic. Patients completed preoperative and postoperative surveys assessing mental health (PHQ-9 [Patient Health Questionnaire]), social support (MOS-SS [Medical Outcomes Study Social Support Survey]), and socioeconomic status (Hollingshead Index [Hollingshead Four Factor Index of Socioeconomic Status]). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and 30-day composite complication rates were measured and categorized by Clavien-Dindo Grade. Bivariate associations of survey data on complications were assessed. Logistic regression analyses were used to identify independent predictors of 30-day complications and complication severity.
RESULTS
Postoperative complications within 30 days occurred in 67 of 273 (24.5%) patients. Most (88.1%) complications were mild, but eight (11.9%) experienced severe complications. Only three patients (1.1%) tested positive for SARS-CoV-2 infection. There were no differences in complication rates when comparing race and ethnicity, age, or socioeconomic status. Survey responses that indicated more depression and worse support from preoperative to postoperative were seen in patients with severe complications ( P =.008 and P =.09, respectively). Multivariate analysis demonstrated that an increase in support scores was protective against severe complications ( P =.02). Worsening depression scores were associated with more severe complications ( P =.03).
CONCLUSION
This study showed a high rate of complications (24.5%) among patients who underwent hysterectomy during the COVID-19 pandemic. Lower social support and worse mental health status are associated with worse postoperative outcomes after hysterectomy.
目的
描述2019年冠状病毒病（COVID-19）大流行期间接受子宫切除术患者的30天术后综合并发症发生率，并确定基线及术后心理健康症状、社会支持水平、社会经济状况及其与子宫切除术后结果的关联。
方法
这项在美国8个中心开展的多中心前瞻性队列研究纳入了在COVID-19大流行期间因良性指征接受微创子宫切除术的患者。患者完成术前和术后调查，评估心理健康（患者健康问卷-9[PHQ-9]）、社会支持（医学结局研究社会支持调查[MOS-SS]）和社会经济状况（霍林斯黑德指数[霍林斯黑德社会经济地位四因素指数]）。测量严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染率和30天综合并发症发生率，并根据Clavien-Dindo分级进行分类。评估并发症调查数据的双变量关联。采用逻辑回归分析确定30天并发症及并发症严重程度的独立预测因素。
结果
273例患者中有67例（24.5%）在术后30天内出现并发症。大多数（88.1%）并发症为轻度，但有8例（11.9%）出现严重并发症。仅3例患者（1.1%）SARS-CoV-2感染检测呈阳性。比较种族和族裔、年龄或社会经济状况时，并发症发生率无差异。严重并发症患者术前至术后显示出更多抑郁和更差支持的调查反应（分别为P = 0.008和P = 0.09）。多变量分析表明，支持得分增加可预防严重并发症（P = 0.02）。抑郁得分恶化与更严重并发症相关（P = 0.03）。
结论
本研究显示，在COVID-19大流行期间接受子宫切除术的患者并发症发生率较高（24.5%）。较低的社会支持和较差的心理健康状况与子宫切除术后更差的术后结果相关。
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