Outcomes of Surgery for Inflammatory Bowel Disease Among Patients with Psychiatric Disorders.

Abstract

Psychiatric disorders are common among patients with inflammatory bowel disease (IBD). Brain-gut dysfunction and psychotropic medications may have adverse effects on postoperative outcomes of IBD patients. The present work aimed to evaluate the association of psychiatric disorder with outcomes following surgery for IBD. This was a retrospective study of adult IBD patients undergoing small bowel, colon, or rectal resection in the 2016-2021 Nationwide Readmissions Database. Psychiatric disorders including psychotic, mood, anxiety, eating, sleep, personality, and childhood-onset behavioral disorders were identified. Records with colorectal cancer were excluded. Multivariable regressions were used to examine the association of psychiatric disorder with outcomes. Of 81,955 patients included in the study, 26.6% had psychiatric disorders. Upon risk adjustment, psychiatric disorder was associated with significantly increased postoperative ileus (AOR 1.11 [95% CI 1.03-1.19]), length of stay (ß +1.4 days [95% CI 1.1-1.7]) and costs (ß +$2,100 [95% CI $1,200-3,100]) compared to no psychiatric disorder. Additionally, patients with psychiatric disorders experienced increased odds of non-home discharge (AOR 1.23 [95% CI 1.12-1.34]) and 30-day readmission (1.32 [1.22-1.43]). Over the study period, the prevalence of psychiatric disorders significantly increased from 24.3% to 28.5% (p<0.001), along with an increase in rates of ileus among patients with psychiatric disorders (8.1 to 15.8%, p<0.001). Psychiatric disorder is associated with significantly greater burden of adverse clinical and financial outcomes following IBD operations. Given the growing prevalence of mental health conditions among patients with IBD, further efforts to optimize preoperative psychiatric care may enhance quality of colorectal surgery.