背景:抑郁症在接受乳房切除术的患者中非常常见。几位乳房切除术后患者选择选择性乳房重建。然而,关于术前抑郁对乳房重建结果影响的证据仍然有限.这项研究旨在评估术前抑郁对自体乳房重建(ABR)和基于植入物的乳房重建(IBR)的短期结果的影响。
方法:从2015-2020年第四季度的全国住院患者样本中确定了接受ABR或IBR的患者。多变量logistic回归用于比较有和无抑郁症患者的住院结局。根据人口统计进行调整,主要付款人身份,医院特色,和合并症。
结果:在12,984名接受ABR的患者中,1578(12%)患有抑郁症,而在接受IBR的17,963名患者中,1980(11%)患有抑郁症。在ABR和IBR中,术前抑郁与较高的浅表伤口并发症(ABR,aOR=1.386,95%CI=1.035-1.856,p=0.03;IBR,OR=1.281,95%CI=1.001-1.638,p=0.04),出血/血肿(ABR,aOR=1.164,95%CI=1.010-1.355,p=0.04;IBR,OR=1.614,95%CI=1.279-2.037,p<0.01),住院时间更长(p<0.01)。在ABR,抑郁症患者感染发生率较高(aOR=1.906,95%CI=1.246~2.917,p<0.01),败血症发生率较高(aOR=15.609,95%CI=1.411~172.65,p=0.03).在IBR,抑郁症患者出现包膜挛缩(aOR=1.477,95%CI=1.105~1.976,p=0.01)和血清肿(aOR=1.489,95%CI=1.005~2.208,p=0.04)的风险较高.
结论:术前抑郁与ABR和IBR后的主要疾病独立相关。术前筛查抑郁症可能是有益的。这项研究的结果可以促进抑郁症患者的术前风险分层和术后护理。
BACKGROUND: Depression is notably common among patients who have undergone mastectomy. Several post-mastectomy patients opt for elective breast reconstruction. However, evidence on the influence of preoperative depression on breast reconstruction outcomes remains limited. This study aimed to evaluate the effect of preoperative depression on the short-term outcomes of autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) using a comprehensive national registry.
METHODS: Patients who underwent ABR or IBR were identified from the national inpatient sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between the patients with and without depression, adjusted for demographics, primary payer status, hospital characteristics, and comorbidities.
RESULTS: Among the 12,984 patients who underwent ABR, 1578 (12 %) had depression whereas 1980 (11 %) out of 17,963 patients who underwent IBR had depression. In ABR and IBR, preoperative depression was associated with higher superficial wound complications (ABR, aOR = 1.386, 95 % CI = 1.035-1.856, p = 0.03; IBR, aOR = 1.281, 95 % CI = 1.001-1.638, p = 0.04), hemorrhage/hematoma (ABR, aOR = 1.164, 95 % CI = 1.010-1.355, p = 0.04; IBR, aOR = 1.614, 95 % CI = 1.279-2.037, p < 0.01), and longer hospital length of stay (p < 0.01). In ABR, patients with depression had higher incidences of infection (aOR = 1.906, 95 % CI = 1.246-2.917, p < 0.01) and sepsis (aOR = 15.609, 95 % CI = 1.411-172.65, p = 0.03). In IBR, patients with depression had higher risks of capsular contracture (aOR = 1.477, 95 % CI = 1.105-1.976, p = 0.01) and seroma (aOR = 1.489, 95 % CI = 1.005-2.208, p = 0.04).
CONCLUSIONS: Preoperative depression is independently associated with major morbidities after ABR and IBR. Preoperative screening for depression can be beneficial. Findings from this study can facilitate preoperative risk stratification and post-operative care for patients with depression.