Laparoscopic versus Open Surgery in patients with psychiatric comorbidity: A retrospective study at the largest psychiatric center in Japan.

Baongoc Nasri, MD1, Masanori Tada, PhD, MD1, Ken Yuu, MD1, Marius Calin, MD2. 1Tokyo Metropolitan Matsuzawa Hospital, 2Saint Vincent Hospital Indianapolis

OBJECTIVES: To compare the outcomes of laparoscopic versus open surgery in patients with psychiatric comorbidity.

BACKGROUND: Several studies have linked the presence of psychiatric disorders to increased risks of distinct diseases and suboptimal outcomes. Although laparoscopic approach is minimally invasive, it is unclear whether laparoscopic surgery is safe for patients with psychiatric comorbidity.

METHOD:  A retrospective chart review of surgical patients with psychiatric comorbidity at a metropolitan hospital in Japan from August 2013 to August 2015 was done. Patients were divided into laparoscopic group (LG) (n=55) and open group (OG) (n=72). The groups were compared by operating time, estimated blood loss, day starting oral intake, length of stay, complication and mortality. Logistic regression analysis was performed to delineate the predictors of complication and mortality. Ordinary least squares regression analysis was performed to delineate the predictors of operating time. Independent variables are age, BMI, ASA, diagnosis of malignant/benign. Statistical analysis was performed using R programming version 0.98.490. A p value of 0.05 was used as statistically significant.

RESULTS: The sample included 68 (63%) patients with schizophrenia, 22 (21%) with dementia, 37 (14%) with others. There were 15 (11.8%) gastrectomies and 34 (26.7%) colorectal resections for malignant diseases. The perioperative data set including the female to male ratio, age, BMI, ASA, the rate of malignant disease showed no difference in the two groups. The conversion rate was 1.8%. The operating time was higher in LG compared to OG (mean [SD], LG 176 [80.6] min vs OG 72 [123] min; (p<0.05). The estimated blood loss was lower in LG compared to OG (mean [SD], LG 101 [222.9] ml vs OG 173 [233.2] ml; (p<0.05). There was no difference in the length of stay, day starting oral intake, complication and mortality between LG and OG. After adjusting for age, BMI, ASA, diagnosis of malignant/benign, LG was associated with a decreased odds ratio for complication and mortality. Multiple linear regressions showed increased operating time in LG compared with OG.

CONCLUSIONS:  Even though laparoscopic surgery had longer operating time, there was no difference in the length of stay, complication and mortality between laparoscopic and open surgery in patients with psychiatric comorbidity. After further study of patient selection criteria, we hypothesize that laparoscopic procedure is a preferred option for the increasing population with underlying psychiatric diseases.

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