Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery.
Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery.
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DOI：
10.1007/s00464-018-6459-7
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发表时间：
2019-05
期刊：
影响因子：
--
通讯作者：
Noria S
中科院分区：
文献类型：
--
作者：
Jalilvand A;Dewire J;Detty A;Needleman B;Noria S
在寻求减肥手术(BS)的患者中，控制良好的或既往的精神诊断对围手术期结果的影响尚不清楚。这项研究的主要目的是确定精神病学诊断对住院时间(LOS)、BS术后30天再住院率和术后体重减轻结果的影响。对2014-2016年间在同一学术机构接受腹腔镜袖状胃切除术(LSG)或Roux-en-Y胃分流术(LRNYGB)的患者进行了回顾。基线人口学数据和精神病史，包括抑郁、焦虑和/或双相情感障碍(DAB)从电子病历中获得。所有患者均获得住院天数、30天再入院天数和超重体重减少率(%EBWL)，并将DAB患者与无任何精神病史的患者进行比较。在研究期间，回顾了354名患者，其中78%是女性；60%接受了LSG。术前平均BMI为48.9±8.4m/kg2。重度抑郁是主要的诊断(42%)，13%的人既有抑郁又有焦虑。30天再住院率显著高于对照组(10.5%vs.3.7%，p=0.02)。平均住院LOS和长住院LOS(≥4天)的发生率在两组间无差异，但在LSGS患者中，长住院LOS的发生率有升高趋势(9.2%vs.4%，P=0.1)。抑郁和焦虑的患者Long Los的发生率较高(23.4%vs.9.2%，p<；0.005)。虽然DAB患者6个月的EBWL显著降低(41%比46%，p=0.004)，但1年的体重减轻结果没有差异，即使调整了手术程序。有基线或有DAB病史的患者早期再住院率显著较高，而那些有多项诊断的患者与住院4天的LOS≥相关。未来的研究应该集中于阐明精神病学诊断对这些质量指标的影响。
The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes. Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history. During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4 m/kg2. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4 days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure. Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.
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