S. Ali1, E. Aguayo1, K. Ali1, A.P. Ng1, T. Coaston1, G. Porter1, S. Sakowitz1, P. Benharash1,2 1David Geffen School Of Medicine, University Of California At Los Angeles, Surgery, Los Angeles, CA, USA 2David Geffen School Of Medicine, University Of California At Los Angeles, Center For Advanced Surgical & Interventional Technology, Los Angeles, CA, USA
Introduction: Psychosocial risk factors (PSRF), including depression and developmental disorders, have increasingly been shown to adversely impact postoperative outcomes. Despite their high prevalence, PSRF and their associated outcomes following emergency general surgery (EGS) remain ill-defined. In the present work, we characterized the association of PSRF with mortality, postoperative complications, hospitalization costs, and 30-day readmissions following EGS.
Methods: The 2016-2021 Nationwide Readmissions Database was queried to identify all adult patients (≥18 years) undergoing EGS (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection). Patients were grouped into the PSRF cohort in the presence of ICD-10 diagnosis codes for mental, behavioral, and neurodevelopmental disorders (others: Non-PSRF). The primary endpoint was in-hospital mortality while several postoperative complications including stroke, thromboembolic, cardiac, renal, respiratory, and infectious complications as well as hospitalization costs, and 30-day nonelective readmissions, were also considered. Multivariable regressions were used to evaluate the association of PSRF with outcomes of interest.
Results: Among an estimated 2,104,962 patients undergoing EGS, 51.8% had PSRF with a stable incidence overtime (52.0 in 2016 to 51.1% in 2021, P=0.66). Compared to others, PSRF were younger (57 [41-69] vs 61 years [44-73]), and less commonly privately insured (26.6 vs 42.2%, all P<0.001). After multivariable adjustment, PSRF was independently associated with increased odds of acute mortality (AOR 1.12, 95% CI 1.08-1.16), sepsis (AOR 1.25, 95% CI 1.23-1.28), pneumonia (AOR 1.34, 95% CI 1.29-1.38), and renal (AOR renal, 95% CI 1.18-1.22; Figure 1) complications. Furthermore, PSRF was significantly associated with a +$1,400 increment in hospitalization costs (β+ $1,350.6, 95% CI 1,200-1,500, P<0.001) and +0.61-day increase in length of stay (β+ 0.61 days, P<0.001). Patients with PSRF experienced 23% increased odds of 30-day readmission (AOR 1.23, 95% CI 1.21-1.25).
Conclusion: The presence of preexisting psychosocial risk factors was associated with increased mortality, postoperative complications, costs, length of stay, and readmission. Identifying psychosocial risk factors early during hospitalization and integrating interdisciplinary social work and psychiatric care may help improve perioperative outcomes.