|
1
|
Kou YF, Wang C, Shah GB, Mitchell RB, Johnson RF. Tonsillectomy Outcomes among Children with Mental Health Disorders in the United States. Otolaryngol Head Neck Surg 2020; 162:754-760. [DOI: 10.1177/0194599820910115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Recent evidence suggests that children with mental health disorders are more likely to have postoperative complications. Our aim was to determine if mental health disorders affect postoperative complications after tonsillectomy with or without adenoidectomy (T&A). Setting Cross-sectional analysis of national databases. Subjects and Methods The 2006 to 2016 Kids Inpatient Database and the 2014 Nationwide Readmission Database were used to identify children (age <21 years) who underwent T&A. We compared children with mental health disorders (eg, autism, developmental delays, or mood disorders) to those without a mental health disorder. We contrasted gender, race, length of stay, complications, and 30-day readmissions. Results We estimated that 37,386 children underwent T&A, and there were 2138 (5.7%) diagnosed with a mental health disorder. Children with mental health disorders were older (6.0 vs 5.3 years, P < .001), more commonly males (64% vs 58%, P < .001), had a longer length of stay (3.4 days vs 2.3 days, P < .001), and had higher total charges even after controlling for length of stay ($19,000 vs $14,000, P < .001). Children with a mental health disorder were more likely to have a complication (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.7 to 3.4; P < .001) including intubation, mechanical ventilation, or both (OR = 3.3; 95% CI, 2.6 to 3.8; P < .001). The 30-day all-cause readmission rate was higher (12% vs 4.0%, P < .001). Conclusion Children with mental health disorders, especially development delays, have more frequent complications, longer lengths of stay, and readmissions than children without mental health disorders. This information should be included in preoperative counseling.
Collapse
Affiliation(s)
- Yann-Fuu Kou
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cynthia Wang
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Gopi B. Shah
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children’s Health, Children’s Medical Center Dallas, Dallas, Texas, USA
| | - Ron B. Mitchell
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children’s Health, Children’s Medical Center Dallas, Dallas, Texas, USA
| | - Romaine F. Johnson
- Department of Otolaryngology–Head and Neck Surgery, Division of Pediatric Otolaryngology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pediatric Otolaryngology, Children’s Health, Children’s Medical Center Dallas, Dallas, Texas, USA
| |
Collapse
|
|
2
|
Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical Cystectomy. J Urol 2015; 195:47-52. [PMID: 26235376 DOI: 10.1016/j.juro.2015.07.095] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Psychological distress has been associated with an impaired immune response and poor wound healing. We hypothesized that preoperative patient reported mental health would be associated with high grade 30-day complications after radical cystectomy. MATERIALS AND METHODS We retrospectively identified patients who underwent radical cystectomy for bladder cancer who completed Short Form 12 (SF-12) surveys for self-assessment of health status less than 6 months before surgery. Median physical and mental composite scores were calculated. An expert model including known predictors of postoperative high grade complications was developed, and SF-12 physical composite score and mental composite score were added to determine their association with this end point. RESULTS From January 2010 to August 2014, 472 patients underwent radical cystectomy for bladder cancer, of whom 274 (58.1%) completed preoperative SF-12 questionnaires. Responders were more likely to be white (p=0.024), have higher preoperative albumin (p=0.037), receive neoadjuvant chemotherapy (p=0.002), have pT3/T4 disease (p=0.044) and have positive soft tissue surgical margins (p=0.006). Median SF-12 physical composite score was 43.1 (IQR 33.0-51.5) and mental composite score was 48.5 (IQR 39.5-54.7) in responders. Overall 46 (16.8%) responders experienced a high grade 30-day complication. Patients with a high grade complication had a lower preoperative median SF-12 mental composite score (44.8 vs 49.8, p=0.004) but no difference in physical composite score (39.2 vs 43.8, p=0.06). SF-12 mental composite score was also a significant predictive variable when added to our expert model (p=0.01). CONCLUSIONS Preoperative patient reported mental health was independently associated with high grade complications after radical cystectomy. Therefore, patient self-assessment of health status before surgery through validated questionnaires may provide additional information useful in predicting short-term postoperative outcomes.
Collapse
|