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. 2019 May;33(5):1661-1666.
doi: 10.1007/s00464-018-6459-7. Epub 2018 Sep 25.

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Anahita Jalilvand  1 , Jane Dewire  1 , Andrew Detty  1 , Bradley Needleman  1 , Sabrena Noria  2
Affiliations

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Anahita Jalilvand et al. Surg Endosc. 2019 May.

Abstract

Background: The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes.

Methods: Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history.

Results: During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4 m/kg2. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4 days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure.

Conclusion: Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.

Keywords: Bariatric surgery; Early readmission; Length-of-stay; Mental-health.

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Conflict of interest statement

Disclosures Dr. Anahita Jalilvand, Dr. Bradley Needleman, Dr. Sabrena Noria, Jane Dewire, and Andrew Detty have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
30-day readmission rate by psychiatric diagnosis. Patients with bipolar disorder or anxiety disorder had significantly higher early readmissions after bariatric surgery compared to patients without baseline major psychiatric diagnoses. Patients with depression or depression and anxiety trended towards higher early readmissions
Fig. 2
Fig. 2
Hospital length of stay ≥ 4 days by psychiatric diagnosis. Patients with depression and anxiety disorders demonstrated significantly higher incidence of long hospitalizations compared to those without baseline major psychiatric diagnoses. Bipolar patients had twice the incidence of long hospitalization after bariatric surgery, although this only trended towards significance
See this image and copyright information in PMC

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