Presence Of Psychiatric Diagnosis Negatively Impacts Patient-Reported Outcomes And Decreases Likelihood Of Autologous Reconstruction
Sumarth K. Mehta, B.S., Amar H. Sheth, B.S., Olamide Olawoyin, B.S., Fouad Chouairi, B.S., John Persing, M.D., Michael Alperovich, M.D., M.Sc..
Yale School of Medicine, New Haven, CT, USA.
PURPOSE: Previous studies suggest that psychiatric health may impact surgical care. However, breast reconstruction studies have not yet evaluated the effect of psychiatric diagnoses on patient satisfaction and health-related quality-of-life. Herein, we quantitatively assess how the presence of psychiatric diagnoses affects patient-reported outcomes. Furthermore, we evaluate whether having a psychiatric diagnosis affects choice of reconstructive modality (implant vs. autologous).
METHODS: Patients who received breast reconstruction at Yale New Haven Hospital between 2013 and 2018 and completed the BREAST-Q survey were included. Patients were sorted: (1) one or more psychiatric diagnoses or (2) no psychiatric diagnoses. T-tests were used to identify significant differences in BREAST-Q module scores, and General Linear Models (GLM) were used to control for confounding factors. A χ2 test was used to assess effect on reconstructive modality, and binary logistic regression was used to control for confounding factors.
RESULTS: Of 471 patients included, 93 had at least one psychiatric diagnosis and 378 had none. Cohorts did not differ significantly by age, BMI, race, ASA classification, or insurance status. Our GLM analysis showed patients with a psychiatric diagnosis experienced a decrease in BREAST-Q scores for Psychosocial Wellbeing (B=9.16, p=0.001) and Sexual Wellbeing (B=9.29, p=0.025). Our binary logistic regression model showed patients with a psychiatric diagnosis were far less likely to receive autologous reconstruction compared to implant reconstruction (OR=0.489, p=0.010).
CONCLUSIONS: Presence of psychiatric diagnoses is an independent predictor of BREAST-Q outcomes and reconstructive modality. Our analysis reflects a significant disparity in care received by patients with psychiatric diagnoses.
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