HealthcarePresented at the Academic Surgical Congress 2017Disparities in operative outcomes in patients with comorbid mental illness
Introduction
It is estimated that almost half of Americans will meet diagnostic criteria for a mental health disorder at some point in their life, and nearly 1 in 8 will be diagnosed with 2 or more mental health disorders.1 Patients with a mental health diagnosis are at an increased risk of developing medical comorbidities such as coronary artery disease2, 3 and lifestyle-related cancers such as lung cancer.4
Patients with comorbid mental disease have worse outcomes when treated for medical conditions.5 Patients with mental health disorders experience worse oncologic outcomes,4 inferior chronic disease management,5 and even excess mortality compared with patients without a mental health diagnosis.6, 7 To date, there is a paucity of literature examining the impact of mental health diagnoses as patients recover from surgery.
The primary aim of this study was to evaluate the relationship between mental health comorbidities and operative outcomes. We hypothesized that patients with mental health comorbidities experience worse surgical outcomes compared with those without a mental health diagnosis.
Section snippets
Data sources and patient population
We conducted a retrospective cohort study using the 2009–2011 National Inpatient Sample database.8 All patients aged 18–90 who underwent one of 4 most common general surgery procedures (cholecystectomy and common duct exploration, colorectal resection, excision and lysis of peritoneal adhesions, and appendectomy) were included as identified by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ).9 Procedure categories were defined by the
Results
We identified 579,851 patients who underwent one of the 4 most common general surgery procedures in the United States between 2009 and 2011. Cholecystectomy and bile duct exploration represented 40.7% of the cohort (n = 236,193), followed by colorectal resection (28.7%; n = 166,244), appendectomy (21.4%; n = 124,317), and excision and lysis of peritoneal adhesions (9.2%; n = 53,097). Of the 579,851 patients, 38,702 (6.67%) had a concurrent mental health diagnosis on admission. Of these, mood
Discussion
This study shows that for patients undergoing common general surgery procedures, the presence of a mental health diagnosis is associated with significantly prolonged postoperative hospital stays and increased odds of postoperative complications. The type of mental health comorbidity and absolute number of mental health comorbidities affects the odds of experiencing an adverse event. Patients with schizophrenia, substance abuse, and 3 or more mental health diagnoses experienced the greatest
Conclusion
Patients with comorbid mental health conditions who undergo the most common general surgery procedures experience a greater incidence of postoperative complications and longer hospitalizations. Recognizing these disparate outcomes is the first step in understanding how to optimize care for this frequently marginalized and medically vulnerable population.
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No financial support was provided for this study.
Abstract presented at the 2017 Academic Surgical Congress (Abstract number 72.10).