Association of psychiatric illness with acute outcomes following emergency general surgery

Prior work has linked severe psychiatric illness (SPI) with greater postoperative mortality and complications following several elective operations. However, this relationship has not been defined in the setting of emergency general surgery (EGS).

The 2016-2021 United States Nationwide Readmissions Database was used to identify all non-elective adult EGS hospitalizations performed within 48 h of admission. SPI was defined using ICD-10 codes for bipolar disorder and schizophrenia. Patients with severe psychiatric illness comprised the SPI cohort (others: Non-SPI). Multivariable linear and logistic regression models were developed to evaluate the independent association of severe psychiatric illness with in-hospital mortality, perioperative complications, and costs.

Of 2,124,284 EGS patients, 52,130 (2.5 %) were categorized as SPI. On adjusted analysis, SPI was associated with greater odds of in-hospital mortality (Adjusted Odds Ratio [AOR] 1.21; 95 % Confidence Interval [CI]:1.11-1.31), hospitalization costs (+$2304; 95 %CI: +1950, +2658), as well as a 3-fold increase in relative risk of non-home discharge (AOR 3.18, 95 % CI: 3.05-3.31).

Among EGS patients, severe psychiatric illness was linked with inferior clinical and financial outcomes. Improved psychiatric screening and care may allow for early intervention and targeted postoperative care, potentially mitigating complications and costs for these vulnerable patients.