The measurable cost of complications for outpatient cosmetic surgery in patients with mental health diagnoses.
BACKGROUND
Mental health conditions, including psychiatric and substance abuse diagnoses, have been associated with poor postoperative outcomes, but no studies have quantified the relationship to date.


OBJECTIVE
The authors examine the association between mental health conditions and immediate postoperative outcomes as defined by further hospital-based acute care within 30 days of surgery.


METHODS
California State Ambulatory Surgery, Inpatient, and Emergency Department Databases were used to identify all adult patients undergoing outpatient cosmetic plastic surgery between January 2007 and October 2011. Patients were subgrouped by the presence of mental health or substance abuse conditions. Primary outcome was the need for hospital-based acute care (admission or emergency department visit) within 30 days after surgery. Multivariable logistic regression models compared outcomes between groups.


RESULTS
Of 116,597 patients meeting inclusion criteria, 3.9% and 1.4% had either a psychiatric or substance abuse diagnosis, respectively. Adjusting for medical comorbidities, patients with psychiatric disorders more frequently required hospital-based acute care within 30 days postoperatively than those without mental illness diagnoses (11.1% vs 3.6%; adjusted odds ratio [AOR], 1.78 [95% confidence interval, 1.59-1.99]). This was true both for hospital admissions (3.5% vs 1.1%; AOR, 1.61 [1.32-1.95]) and emergency department visits (8.8% vs 2.7%; AOR, 1.88 [1.66-2.14]). The most common acute diagnoses were surgical in nature, including postoperative infection, hemorrhage, and hematoma; the median hospital admission charge was $35 637. Similar findings were noted among patients with a substance abuse diagnosis.


CONCLUSIONS
Mental health conditions are independently associated with the need for more frequent hospital-based acute care following surgery, thus contributing to added costs of care. A patient's mental health should be preoperatively assessed and appropriately addressed before proceeding with any elective procedure.


METHODS
4.
Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
Sunishka M
SM
Wimalawansa
Justin P
JP
Fox
R Michael
RM
Johnson
D000556:Ambulatory Surgical Procedures; D002140:California / Q000453:epidemiology; D003357:Cosmetic Techniques / Q000706:statistics & numerical data; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D006278:Medicare; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States
acute care; ambulatory surgery; emergency department visits; mental health; plastic surgery; readmission; substance abuse; surgical outcomes