Comparison of Reconstructive Plastic Surgery Rates and 30-Day Postoperative Complications Between Patients With and Without Psychiatric Diagnoses

Abstract

Background Psychiatric comorbidity is associated with greater 30-day postoperative complication rates in various surgical specialties, but is not well characterized for reconstructive plastic surgery. Objective To compare reconstructive plastic surgery rates and 30-day postoperative complications between patients with and without psychiatric diagnoses. Methods Retrospective cohort study comparing patients with and without psychiatric diagnoses. Data were collected from the IBM® MarketScan® Commercial and Medicare Supplemental Databases between January 1, 2007 and December 31, 2015. Rates of reconstructive plastic surgery, demographic data, covariant diagnoses, and 30-day postoperative complications were collected. Multivariable logistic regression assessed differences between the two groups. Results Of 1,019,128 patients (505,715 with psychiatric diagnoses and 513,423 without psychiatric diagnoses) assessed, reconstructive plastic surgery rates were between 4.8-7.0% in those with psychiatric diagnoses, compared to 1.6% in patients without psychiatric diagnoses. The greatest odds of undergoing reconstructive plastic surgery were in patients with BDD (aOR 3.16; 95% CI 1.76-5.67), and anxiety disorder (aOR 3.08; 95% CI 2.97-3.17). When assessing 1,234,206 patients (613,400 with psychiatric diagnoses and 620,806 without psychiatric diagnoses) all of whom underwent reconstructive plastic surgery, two-fold greater odds of any 30-day postoperative complication was associated with psychiatric diagnoses (aOR 2.01; 95% CI 1.28-3.11), as well as greater odds of specific complications (surgical site infection, bleeding, and hospital admission). Of all factors assessed, eating disorder diagnosis was associated with the greatest odds of a complication (aOR 4.17; 95% CI 3.59-4.86), followed by nasal surgery (aOR 3.65; 95% CI 2.74-4.89), and BDD (aOR 3.16; 95% CI 1.76-5.67). Conclusions Diagnosis of a psychiatric condition is associated with greater rates of reconstructive plastic surgery, and two-fold greater odds of 30-day postoperative complications.

An Evaluation of the Impact of Mental Illness on Postoperative Breast Reconstruction Revision Surgery

“…In a MarketScan database study conducted from 2007 to 2015 comparing patients with and without psychiatric diagnoses undergoing reconstructive plastic surgery (N = 505,715), the authors found that patients with psychiatric disorders had a 5.53% rate of complication (ie, surgical site infections, wound-healing complications, bleeding/hematoma, and hospital admission) versus 2.03% in nonpsychiatric patients (OR, 2.00; 95% CI, 1.28–3.11). 18 In addition, in 2019, Orr et al 5 found that preoperative anxiety (OR, 4.34; 95% CI, 1.31–14.38; P = 0.016) was a significant predictor for receiving a revision operation after undergoing autologous breast reconstruction. These findings demonstrate that mental health impacts the overall postoperative course for reconstructive plastic surgery patients.…”

Efficacy of PECS block in addition to multimodal analgesia for postoperative pain management in patients undergoing outpatient elective breast surgery: A retrospective study

“…A later study by Qin et al , also examining the data collected from NSQIP, reported the overall incidence of complications after breast cancer surgery was 5.4% ( 54 ). More recently, Spataro et al , conducted a retrospective study from a secondary data repository which included a sample of 513,423 subjects and reported a 1.6% incidence of complications after ambulatory breast augmentation surgery ( 55 ).…”

Novel Selection Tools in Rhinoplasty Patients

“…3,47 The same large-scale database study of plastic surgery patients mentioned above found that psychiatric diagnoses are associated with a twofold greater risk of 30day complications after reconstructive plastic surgery procedures, which is comparable to what is seen in other specialties. 50 The types of complications seen included bleeding, infection, and hospital readmission and thus were not necessarily related to cosmetic dissatisfaction but rather were presumably related to biological differences in immune function and wound healing.…”

“…For example, in a large-scale database study of over 1,000,000 patients, Spataro et al demonstrated that patients with psychiatric diagnosis, and BDD in particular, were associated with the greatest odds of undergoing reconstructive plastic surgery, at three times the odds of those without psychiatric diagnoses, as shown in ►Table 1. 50 Why is this so important? It turns out that the rates of complication in patients with psychiatric disorders, and BDD in particular, are higher than patients without mental health disorders.…”