Psychiatric comorbidity in emergency general surgery patients: a prospective observational study

• Published in: Trauma surgery & acute care open Vol. 8; no. 1; p. e001117
• Main Authors: Geier, Timothy J, Simske, Natasha, Melin, Sarah, Trevino, Colleen, Murphy, Patrick, Schroeder, Mary Elizabeth, Brandolino, Amber, deRoon-Cassini, Terri, Schramm, Andrew T
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-08-2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Anxiety disorders; Cancer; Comorbidity; emergency general surgery; Gallbladder diseases; Hospitalization; Hospitals; Medical records; Medical screening; Mental depression; Mental disorders; Mental health; Mortality; Observational studies; Original Research; Pain; Patients; Post traumatic stress disorder; psychiatric disorder; Psychopathology; Social support; Surgery; Trauma
• ISSN: 2397-5776; 2397-5776
• DOI: 10.1136/tsaco-2023-001117

ObjectivesAnnually, approximately 27 million individuals in the United States are admitted to hospitals for emergency general surgery (EGS). Approximately 50% develop postoperative complications and 22% require unplanned readmission within 90 days, highlighting a need to understand factors impacting well-being and recovery. Psychiatric comorbidity can impact medical treatment adherence, cost, and premature mortality risk. Despite the severity of illness in EGS, there is limited research on psychiatric comorbidity in EGS patients. Thus, the purpose of the current study was to characterize EGS patient mental health and to assess its relationship with pain, social support, and healthcare utilization (ie, length of stay, readmission).MethodsAdult EGS patients were screened for participation during hospitalization. Inclusion criteria included: (1) 18 years or older, (2) communicate fluently in English, and (3) assessed within 7 days of admission. Participants (n=95) completed assessment, which included a structured clinical diagnostic interview. Record review captured medical variables, including length of stay, discharge disposition, narcotic prescription, and 90-day readmission rates.ResultsNinety-five patients completed the assessment, and 31.6% met criteria for at least one current psychiatric diagnosis; 21.3% with a major depressive episode, 9.6% with a substance use disorder, and 7.5% with post-traumatic stress disorder (PTSD). Lower perceived social support and greater pain severity and interference were significantly related to more severe depression and anxiety. Depression was associated with longer length of stay, and those with PTSD were more likely to be re-admitted.ConclusionThe EGS patient sample exhibited psychiatric disorder rates greater than the general public, particularly regarding depression and anxiety. Screening protocols and incorporation of psychological and social interventions may assist in recovery following EGS.Level of evidenceLevel II, prognostic.