Postdischarge Mental Health Care and Emergency General Surgery Readmission for Patients With Serious Mental Illness

Abstract

Objective: To determine the association between postdischarge mental health care and odds of readmission after emergency general surgery (EGS) hospitalization for patients with serious mental illness (SMI).

Background: A mental health visit (MHV) after medical hospitalization is associated with decreased readmissions for patients with SMI. The impact of a MHV after surgical hospitalization is unknown.

Methods: Using Medicare claims, we performed a retrospective cohort study of hospitalized EGS patients with SMI aged above 65.5 (2016-2018). EGS included colorectal, general abdominal, hepatopancreatobiliary, hernia, intestinal obstruction, resuscitation, and upper gastrointestinal conditions. SMI was defined as schizophrenia spectrum, mood, or anxiety disorders. The exposure was MHV within 30 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included emergency department presentation and psychiatric admission. Inverse probability weighting was used to evaluated outcomes.

Results: Of 88,092 analyzed patients, 11,755 (13.3%) had a MHV within 30 days of discharge. 23,696 (26.9%) of patients were managed operatively, 64,395 (73.1%) nonoperatively. After adjustment for potential confounders, patients with a postdischarge MHV had lower odds of acute care readmission than patients without a MHV in both operative (OR=0.60; 95% CI: 0.40-0.90) and nonoperative (OR=0.67; 95% CI: 0.53-0.84) cohorts. There was no association between postdischarge MHV and ED presentation or psychiatric admission in the operative or nonoperative groups.

Conclusions: Postdischarge MHV after EGS hospitalization was associated with decreased odds of readmission for patients with SMI managed operatively and nonoperatively. In older EGS patients with SMI, coordination of MHVs may be a mechanism to reduce readmission disparities.