Eric P Kubat, MD1, Nina Bellatorre, RN1, Dan Eisenberg, MD2. 1Palo Alto VA Health Care System, 2Palo Alto VA Health Care System and Stanford School of Medicine
A preoperative psychosocial assessment of patients seeking bariatric surgery is common in bariatric surgical practice. However, there is no consensus as to the postoperative effect of a psychiatric diagnosis. Our objective was to determine whether a DSM-IV Axis-I diagnosis impacts early postoperative readmission rates, follow-up rates, and weight loss after bariatric surgery.
We performed a retrospective review of a prospective bariatric surgery database at a university-affiliated Veterans Affairs medical center. Demographics, readmission rates, healthcare system follow-up and weight loss were compared between cohorts, with and without a DSM-IV Axis-I psychiatric diagnosis. Significant differences between the cohorts were determined using Fisher’s exact test and t-test. A significant difference was determined by p<0.05.
From 2002-2014, 249 patients underwent bariatric surgery (49.8% gastric bypass, 50.2% laparoscopic sleeve gastrectomy). Of these, 78% were male, mean age was 53 years, and mean preoperative body mass index (BMI) was 45.8 kg/m2. A DSM-IV Axis-I psychiatric diagnosis was present in 143 (57.4%) of the patients at the time of surgery (PD group), while 106 (42.6%) of the patients had no psychiatric diagnosis (NPD group). The most common Axis-I diagnoses were major depression in 84 patients (58.7%), post-traumatic stress disorder in 52 patients (36.3%), and alcohol dependence/polysubstance abuse in 30 patients (21%). Seventy six patients (53.1%) carried two or more Axis-I diagnoses. There was no significant difference in the mean age (52.6 and 53.6 years, p=0.406) and mean BMI (45.4 kg/m2 and 46.5 kg/m2, p=0.259) between the PD and NPD groups, respectively. Early hospital readmission rates (within 30 days) after bariatric surgery were similar; 2.7% in the PD group compared to 2.8% in the NPD group. Follow-up within the healthcare system at 1, 3 and 5 years postoperatively was 97.5%, 90.0%, and 83.1% in the PD cohort, and 96.7%, 82.9%, and 66.0% in NPD cohort. These differences were not statistically significant at 1 and 3 years (p= 0.653 and 0.236). However, the 5-year follow-up in the PD group was significantly higher (p=0.046). Percent excess weight loss in the PD group was 63.7%, 62.4%, and 60.2% at 1, 3, and 5 years, respectively. This was not significantly different from the NPD group with 59.8%, 55.6%, and 54.0% at 1 (p=0.261), 3 (p=0.139) and 5 years (p=0.228), respectively.
The majority of patients at this Veterans Affairs medical center had a DSM IV Axis-I psychiatric diagnosis at the time of bariatric surgery. Patients with a psychiatric diagnosis undergoing bariatric surgery have a low early readmission rate, a high rate of postoperative follow up, and similar postoperative weight loss compared to patients without a concurrent psychiatric diagnosis. A DSM IV Axis-I psychiatric diagnosis should not be a barrier to access of bariatric surgery.