History of depression is associated with worsened postoperative outcomes following colectomy.
History of depression is associated with worsened postoperative outcomes following colectomy.
复制标题
抑郁症史与结肠切除术后预后恶化有关。
DOI：
10.1111/codi.15790
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Safar,Bashar
中科院分区：
文献类型：
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作者：
Zhang,GeorgeQ;Canner,JosephK;Prince,ElizabethJ;Stem,Miloslawa;Taylor,JamesP;Efron,JonathanE;Atallah,Chady;Safar,Bashar
抑郁症是一种与不良健康结果相关的流行疾病，但对其在结直肠手术中的影响的了解仍然有限。本研究的目的是探讨抑郁史对结肠切除术患者的影响。（2010-2017年）接受结肠切除术的患者被纳入，并根据他们在过去一年内是否有抑郁症史进行分层，定义为（1）在索引入院期间诊断为抑郁症，（2）在任何住院期间或（3）一年内的门诊入院期间诊断为抑郁症，和/或（4）一年内的抗抑郁药药房索赔。主要结果是住院时间（LOS）和住院费用。次要结局包括院内死亡率和术后并发症。Logistic，负二项，分位数回归进行results.ResultsAmong 88 981例，21 878（24.6%）有抑郁症的历史。与无抑郁症史的患者相比，有抑郁症史的患者的LOS显著延长（IRR = 1.06，95% CI [1.05，1.07]），住院费用增加（β = 467，95% CI [167，767]），调整后院内死亡率增加（OR = 1.37，95% CI [1.08，1.73]）。抑郁症史与呼吸系统并发症、肺炎和谵妄的发生率独立相关（P < 0.05）。结论结肠切除术患者抑郁症史普遍存在，与死亡率、住院费用、住院时间和术后并发症的发生率相关。这些发现强调了结直肠手术患者抑郁的影响，并建议适当的识别和治疗可能会降低术后发病率。
AimDepression is a prevalent disorder that is associated with adverse health outcomes, but an understanding of its effect in colorectal surgery remains limited. The purpose of this study was to examine the impact of history of depression among patients undergoing colectomy.MethodUnited States patients from Marketscan (2010–2017) who underwent colectomy were included and stratified by whether they had a history of depression within the past year, defined as (1) a diagnosis of depression during the index admission, (2) a diagnosis of depression during any inpatient or (3) outpatient admission within the year, and/or (4) a pharmacy claim for an antidepressant within the year. The primary outcomes were length of stay (LOS) and inpatient hospital charge. Secondary outcomes included in‐hospital mortality and postoperative complications. Logistic, negative binomial, and quantile regressions were performed.ResultsAmong 88 981 patients, 21 878 (24.6%) had a history of depression. Compared to those without, patients with a history of depression had significantly longer LOS (IRR = 1.06, 95% CI [1.05, 1.07]), increased inpatient charge (β = 467, 95% CI [167, 767]), and increased odds of in‐hospital mortality (OR = 1.37, 95% CI [1.08, 1.73]) after adjustment. History of depression was also independently associated with increased odds of respiratory complication, pneumonia, and delirium (allP< 0.05).ConclusionHistory of depression was prevalent among individuals undergoing colectomy, and associated with greater mortality and inpatient charge, longer LOS, and higher odds of postoperative complication. These findings highlight the impact of depression in colorectal surgery patients and suggest that proper identification and treatment may reduce postoperative morbidity.