Zelia K Chiu1, Paul R Burton1,2, Kalai Shaw1, Yazmin Johari1,2,Chiara Chadwick1,2,, Lauren A Hunt1, Wendy A Brown1,2
1. The Alfred, Oesophago-Gastric-Bariatric Surgery, Melbourne, Victoria
2. Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria
The effect of psychiatric disorders on outcomes post-bariatric surgery is controversial. Literature has demonstrated both similar and poorer weight loss outcomes, and limited research remains regarding key performance indexes on early postoperative outcomes. We aimed to compare weight loss and early postoperative outcomes in bariatric surgery patients with and without Axis I psychiatric disorders.
This is a retrospective cohort study of patients who underwent primary laparoscopic gastric banding (LAGB) or laparoscopic sleeve gastrectomy (LSG) in a tertiary public hospital from January 2008 to May 2018. Demographic data was collected, and patients with non-Axis I psychiatric disorders were excluded. Excess weight loss percentage (%EWL) was collated as outcome measures over 5 years. Unplanned 30-day re-admissions were collated as secondary outcome measures.
965 patients were identified altogether, 423 with an Axis I psychiatric disorder (Axis-I) and 542 with no psychiatric history (control). The Axis-I group included the diagnoses: depression (n=118), BPAD (n=24), anxiety (n=79) and psychosis (n=16). Baseline demographics were statistically similar. The median (IQR) 2-year %EWL of the Axis-I group was 52.9% (29.3,100.3) (p=0.5), compared to the control group 54.4% (29.4,92.9). The median (IQR) 5-year %EWL of the Axis-I group was 41.5% (25.3,59.9) (p=0.5), compared to the control group 48.6% (28.8,65.8). In the LAGB group, there were 32 30-day readmissions, Axis-I n=18, control n=14 (p=0.08). 19 patients were admitted for symptoms (including pain and nausea) without underlying pathology (Axis-I n=13 vs control n=6, p=0.02).
We demonstrated comparable weight loss outcomes for patients with and without psychiatric disorders. While unplanned 30-day readmissions were comparable between patients with and without psychiatric conditions, patients with psychiatric conditions were significantly more likely to be readmitted for symptoms without underlying pathology. Further studies are recommended to assess long-term weight loss outcomes and possible early maladaptive patterns of patients with psychiatric conditions.