A. Lauria2, V. Haney1, J. S. Kim1, A. Kulaylat1, S. Armen1, M. Boltz1, S. Allen1 1Milton S. Hershey Medical Center,Hershey, PA, USA 2Walter Reed Medical Center,Bethesda, MARYLAND, USA
Introduction: Mental health disorders offer a challenge to the care of patients across medical and surgical specialties. The impact of mental health disorders on the emergency general surgery (EGS) population is largely unstudied. We aimed to identify the prevalence of psychiatric disorders in EGS patients, and hypothesized that those with mental health comorbidities who underwent emergent procedures would have worse postoperative outcomes and require more intensive resource utilization.
Methods: Using standard NSQIP practices, data were collected on adult patients admitted for emergent cholecystectomy or appendectomy at a single academic center between 04/01/07 and 01/01/16. Charts were reviewed for psychiatric comorbidities and psychotropic medications. Logistic regression was used to determine the impact of psychiatric comorbidities on postoperative complications, ED visits, and readmission within 30 days.
Results: Of the 641 patients identified (appendectomy n=491 and cholecystectomy n=150), 115 patients (17.9%) had psychiatric comorbidities. Mood disorders were most common (76.5%), followed by anxiety or adjustment disorders (41.7%). Patients with psychiatric comorbidities experienced longer hospitalizations (median 2 vs. 1 days, p<0.001) and required more subsequent ED visits (18.3% vs. 10.3%, p=0.016) compared to those without a psychiatric diagnosis. On multivariable analysis, the presence of psychiatric comorbidities was associated with nearly twice the odds of ED visits within 30 days (OR 1.92, 95% CI 1.01 to 3.68).
Conclusions: Patients with mental health comorbidities who undergo emergency general surgery burden the healthcare system with longer lengths of stay and more ED visits. Protocols and patient education focused on those with mental health disorders may improve these outcomes.