Methods/Technique:
Using the linked California State Ambulatory Surgery, Inpatient, and Emergency Department Databases, we identified all adult patients who underwent outpatient aesthetic surgery between January 2007 and October 2011. Patients were then sub-grouped according to the presence of a mental health condition. Our primary outcome was the need for a hospital-based, acute care encounter, whether hospital admission or emergency department visit, within 30-days of surgery. Multivariable logistic regression models were constructed to compare outcomes between groups.
Results/Complications: Of 116,597 patients who met inclusion criteria, 3.9% and 1.4% had a psychiatric disorder or substance abuse diagnosis respectively. After controlling for co-morbid medical conditions, patients with a psychiatric disorder more frequently experienced at least one hospital-based, acute care encounter within 30-days of surgery (11.1% vs. 3.6%; adjusted odds ratio=1.78 [95% confidence interval=1.59-1.99]). This association was true for both hospital admissions (3.5% vs. 1.1%; AOR=1.61 [1.32-1.95]) and emergency department visits (8.8% vs. 2.7%; AOR=1.88 [1.66-2.14]). The most common diagnoses associated with these encounters were post-operative infection, hemorrhage, and hematoma. Similar findings were noted among patients with a substance abuse diagnosis.
Conclusion: Mental health conditions are independent risk factors for poor outcomes in outpatient aesthetic surgery as defined by hospital-based, acute care encounters. This study quantifies the risk of offering aesthetic surgery services to patients with mental health conditions and supports appropriate preoperative screening.