Association of psychosocial risk factors on outcomes of patients undergoing emergency general surgery Accepted at Academic Surgical Congress

INTRODUCTION: Psychosocial risk factors, including depression and developmental disorders, have increasingly been shown to adversely impact postoperative outcomes. Despite their high prevalence, psychosocial risk factors and their associated outcomes after emergency general surgery remain ill-defined. In the present work, we characterized the association of psychosocial risk factors with mortality, postoperative complications, hospitalization costs, and 30-day readmissions after emergency general surgery. METHODS: The 2016-2021 Nationwide Readmissions Database was queried to identify all adult patients (≥18 years) undergoing emergency general surgery (appendectomy, cholecystectomy, laparotomy, large bowel resection, perforated ulcer repair, or small bowel resection). Patients were grouped into the psychosocial risk factors cohort in the presence of International Classification of Diseases, Tenth Revision, diagnosis codes for mental, behavioral, and neurodevelopmental disorders (others: non-psychosocial risk factors). The primary end point was in-hospital mortality whereas several postoperative complications including stroke, thromboembolic, cardiac, renal, respiratory, and infectious complications as well as hospitalization costs, and 30-day nonelective readmissions, also were considered. Multivariable regressions were used to evaluate the association of psychosocial risk factors with outcomes of interest. RESULTS: Among an estimated 2,104,962 patients undergoing emergency general surgery, 51.8% had psychosocial risk factors with a stable incidence over time (52.0% in 2016 to 51.1% in 2021, P = .66). Compared with others, those with psychosocial risk factors were younger (57 [41-69] vs 61 years [44-73]) and less commonly privately insured (26.6 vs 42.2%, all P < .001). After multivariable adjustment, psychosocial risk factors were independently associated with increased odds of acute mortality adjusted odds ratio, 1.12, 95% confidence interval, 1.08-1.16), sepsis (adjusted odds ratio, 1.25, 95% confidence interval, 1.23-1.28), pneumonia adjusted odds ratio, 1.34, 95% confidence interval, 1.29-1.38), and renal adjusted odds ratio, renal, 95% confidence interval, .18-1.22) complications. Furthermore, psychosocial risk factors were significantly associated with a +$1,400 increment in hospitalization costs (β+ $1,350.6, 95% confidence interval, 1,200-1,500, P < .001) and +0.61-day increase in length of stay (β+ .61 days, P < .001). Patients with psychosocial risk factors experienced 23% increased odds of 30-day readmission adjusted odds ratio, 1.23, 95% confidence interval, 1.21-1.25). CONCLUSION: The presence of preexisting psychosocial risk factors was associated with increased mortality, postoperative complications, costs, length of stay, and readmission. Identifying psychosocial risk factors early during hospitalization and integrating interdisciplinary social work and psychiatric care should be studied.