Abstract
BackgroundGastric bypass (GBP) surgery is considered a safe and effective treatment for obesity. However, there is uncertainty regarding the impact of preexisting psychiatric comorbidity on GBP complications. We have investigated whether a psychiatric diagnosis before GBP surgery is associated with delayed discharge (the odds of being in the 90th percentile of length of stay) and rate of reoperation in a nationwide Swedish cohort.MethodsPatients undergoing GBP surgery during 2008–2012 were identified and followed up through the National Patient Register and the Prescribed Drug Register. Logistic regression models were fitted to the studied outcomes.ResultsAmong the 22,539 patients identified, a prior diagnosis of bipolar disorder, schizophrenia, depression, neurotic disorders, ADHD (attention deficit hyperactivity disorder), substance use disorder, eating disorder, personality disorder, or self-harm since 1997 (n = 9480) was found to be associated with delayed discharge after GBP surgery (odds ratio [OR] = 1.47, confidence interval [CI] 1.34–1.62), especially in patients with psychiatric hospitalization exceeding 1 week in the 2 years preceding GBP surgery (OR = 2.06, CI 1.30–3.28), compared with those not hospitalized within psychiatry. Likewise, patients with a prior psychiatric diagnosis were more likely to be reoperated within 30 days (OR = 1.25, CI 1.11–1.41), with twice the likelihood OR 2.23 (CI 1.26–3.92) for patients with psychiatric hospitalization of up to a week in the 2 years preceding GBP surgery, compared with patients who had not been hospitalized within psychiatry.ConclusionsA psychiatric diagnosis before GBP surgery was associated with delayed discharge and increased likelihood of reoperation within 30 days. Patients with a prior psychiatric diagnosis may, therefore, need additional attention and support.
Highlights
MethodsObesity is increasing worldwide, including patients suffering from psychiatric disorders
We identified any psychiatric diagnosis recorded in the National Patient Register before Gastric bypass (GBP) surgery, based on ICD-10 diagnoses at inpatient or specialized psychiatric outpatient services
The average length of stay postsurgery decreased during the study period, from an average of 4.3 days in 2008 to 2.3 days in 2012 (p < 0.05)
Summary
MethodsObesity is increasing worldwide, including patients suffering from psychiatric disorders. In a study of more than 10,000 Canadian patients seeking bariatric surgery, 51% had a past or present psychiatric diagnosis, most commonly depression, which was found in 41.7% of the group [3]. 33.2% had a prior diagnosis of alcohol abuse or dependence [4]. In another North American sample, 6% of patients screened positive for bipolar symptoms preoperatively [5]. Gastric bypass (GBP) surgery is considered a safe and effective treatment for obesity. We have investigated whether a psychiatric diagnosis before GBP surgery is associated with delayed discharge (the odds of being in the 90th percentile of length of stay) and rate of reoperation in a nationwide Swedish cohort
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