Elevated Cardiopulmonary Complications after Revascularization in Patients with Severe Mental Health Disorders.
Elevated Cardiopulmonary Complications after Revascularization in Patients with Severe Mental Health Disorders.
复制标题
DOI：
10.33425/2639-8486.1122
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Ruddy, Jean Marie
中科院分区：
文献类型：
--
作者：
Gober, Leah;Brown, Adam;Bunnell, Avianne P;Bunnell, Brian E;Ruddy, Jean Marie
精神健康障碍（MHD）在外科患者人群中很普遍，可能与术后结局较差相关，特别是在那些患有更严重MHD（精神分裂症和双相情感障碍）的患者中。然而，这些相关性尚未在血管手术患者中进行研究。本研究调查了接受下肢血运重建的患者，假设重度MHD患者的健康状况和术后结局更差。对2010-2015年需要血运重建的外周动脉疾病（PAD）患者进行了回顾性病历审查，随后缩小了合并MHD诊断的患者范围，包括定义为双相情感障碍或精神分裂症的重度MHD（sMHD）和定义为焦虑或抑郁的非重度MHD（nsMHD）。主要终点为30天死亡率;主要肢体不良事件（MALE），包括膝上或膝下截肢;主要心脏不良事件（MACE），包括心肌梗死（MI）、充血性心力衰竭（CHF）恶化和心律失常。次要终点为30天内再入院、肺部并发症和伤口感染。统计分析包括Fisher精确检验和Student's T检验。确定并分层了18例MHD患者（sMHD，n=10; nsMHD，n=8）。24条肢体进行了血运重建（sMHD，n=13; nsMHD，n=11）。30天死亡率、MALE和MACE的总体发生率分别为4.2%、33.3%和50.0%。再入院率、肺炎和伤口感染发生率分别为41.7%、20.8%和16.7%。按MHD严重程度分层，未观察到医学合并症、男性、介入类型（开放vs.血管内）或治疗适应症（跛行vs.严重肢体缺血）的显著差异。与nsMHD患者相比，sMHD患者的MACE发生率显著更高（30.8% vs. 18.2%，p<0.05）。肺炎在该组中也更普遍（38.5% vs. 0.0%，p<0.05）。虽然同时诊断为MHD和PAD的患者具有相似的合并症，疾病严重程度相当，并且通过开放与血管内技术进行同等治疗，但重度MHD患者的心肺并发症发生率显著升高，特别是MACE和肺炎。进一步的调查是必要的，以确定优化这些复杂患者的术后护理的机会。
Mental health disorders (MHD) are prevalent within surgical patient populations and can be associated with poorer postoperative outcomes, particularly in those with more severe MHD (schizophrenia and bipolar disorder). However, these associations have not been examined in vascular surgery patients. This study investigated patients undergoing lower extremity revascularization, hypothesizing that those with severe MHD would experience worse health and postoperative outcomes. A retrospective chart review of patients from 2010–2015 with peripheral arterial disease (PAD) requiring revascularization was conducted, with subsequent narrowing to those with concurrent MHD diagnoses, including severe MHD (sMHD) defined as bipolar disorder or schizophrenia and non-severe MHD (nsMHD), defined as anxiety or depression. The primary endpoints were 30-day mortality; Major Adverse Limb Events (MALE) including amputation at the above or below knee level; and Major Adverse Cardiac Events (MACE) including myocardial infarction (MI), congestive heart failure (CHF) exacerbation, and arrhythmia. Secondary endpoints were readmission within 30 days, pulmonary complications, and wound infection. Statistical analyses included Fisher Exact Test and Student’s T-test. Eighteen patients with MHD (sMHD, n=10; nsMHD, n=8) were identified and stratified. Twenty-four limbs were revascularized (sMHD, n=13; nsMHD, n=11). Overall incidence of 30-day mortality, MALE, and MACE were 4.2%, 33.3%, and 50.0%, respectively. Readmission rate, pneumonia, and wound infection occurred in 41.7%, 20.8%, and 16.7% of the population. Stratifying by MHD severity, no significant differences were observed for medical comorbidities, MALE, intervention type (open vs. endovascular), or treatment indication (claudication vs. critical limb ischemia). Patients with sMHD had significantly higher rates of MACE compared to patients with nsMHD (30.8% vs. 18.2%, p<.05). Pneumonia was also more prevalent in this group (38.5% vs. 0.0%, p<.05). While patients with concurrent diagnoses of MHD and PAD presented with similar comorbidities, comparable disease severity, and were equally treated by open versus endovascular techniques, those with severe MHD suffered significantly elevated rates of cardiopulmonary complications, specifically MACE and pneumonia. Further investigation is warranted to identify opportunities to optimize post-operative care for these complex patients.