Anahita D Jalilvand, MD, Jane Dewire, BS, Andrew Detty, BS, Bradley Needleman, MD, Sabrena Noria, MD, PhD. The Ohio State Wexner Medical Center
BACKGROUND: In order to qualify for bariatric surgery (BS), patients must undergo psychiatric evaluation to assess their capacity to incorporate the necessary lifestyle changes. While contraindications to surgery include substance abuse, psychosis, binge eating or severe personality disorders, it is unclear how actively treated diagnoses such as depression, bipolar disorder, and panic disorders affect surgical outcomes. The primary objective of this study was to determine the impact of psychiatric diagnoses on prolonged hospital length of stay (LOS) and 30-day readmission rates after BS.
METHODS: Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) between July 2014 and June 2016 at a single academic institution were retrospectively reviewed. Baseline demographic, psychiatric history, and operative data were obtained from the electronic medical record. Hospital LOS and 30-day readmissions were obtained for each patient. Student’s t-test, Mann-Whitney U, Chi squared, and Fisher’s Exact were utilized to calculate significance. A p-value of <0.05 was considered significant.
RESULTS: During the study period, 361 patients were reviewed, of which 78.39% (n=283) were female and the mean age was 45.04 ± 10.42 years. Sixty percent underwent LSG (n=216) and 40% underwent LRNYGB (n=145). The mean preoperative BMI was 48.86 ± 8.38 m/kg2. Major depression was the leading psychiatric diagnosis (42.02%, n=150), followed by anxiety (22.51%, n=79) and bipolar disorder (3.06%, n=11). The incidence of depression was significantly higher for patients with Medicaid/Medicare versus private insurance (55.93% vs 39.60%, p = 0.020) and for women compared to men (31.29% vs 13.61%, p<0.005). Surgery type was not different between those with and without psychiatric diagnoses. Patients with a psychiatric history trended towards a longer hospital LOS (≥4 days) (13.61% vs 9.20%, p=0.20). Specifically, patients diagnosed with depression were more likely to have a longer hospital LOS (15.23% vs 8.74%, p=0.057). Compared to those without any psychiatric history, patients with either bipolar disease, depression, or anxiety were significantly more likely to be readmitted within 30 days (10.68% vs 3.68%, p=0.015), and the early readmission rate was significantly higher for patients with bipolar disorder (45.45% vs 6.03%, p<0.005).
CONCLUSION: Patients with major psychiatric diagnoses trended towards a longer hospital LOS and were significantly more likely to be readmitted within 30 days after BS. This not only underscores the importance of careful preoperative psychiatric screening, but also suggests that these patients may need increased support in the preoperative, in-hospital, and post-operative settings.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87860
Program Number: S039
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium