Post-discharge Mental Healthcare and Emergency General Surgery Readmission for Patients with Serious Mental Illness

Danielle E Brown; Claire B Rosen; Sanford E Roberts; Adora Moneme; Chris Wirtalla; Rachel Kelz

doi:10.1097/SLA.0000000000006302

Post-discharge Mental Healthcare and Emergency General Surgery Readmission for Patients with Serious Mental Illness

Ann Surg. 2024 Apr 19. doi: 10.1097/SLA.0000000000006302. Online ahead of print.

Authors

Danielle E Brown¹, Claire B Rosen², Sanford E Roberts², Adora Moneme¹, Chris Wirtalla³, Rachel Kelz^{2

3

4}

Affiliations

¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
² Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
³ Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
⁴ Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.

PMID: 38639084
DOI: 10.1097/SLA.0000000000006302

Abstract

Objective: To determine the association between post-discharge mental healthcare and odds of readmission after emergency general surgery (EGS) hospitalization for patients with serious mental illness (SMI).

Background data: A mental health visit (MHV) after medical hospitalization is associated with decreased readmissions for patients with SMI. The impact of a MHV after surgical hospitalization is unknown.

Methods: Using Medicare claims, we performed a retrospective cohort study of hospitalized EGS patients with SMI aged >65.5 (2016-2018). EGS included colorectal, general abdominal, hepatopancreatobiliary, hernia, intestinal obstruction, resuscitation, and upper gastrointestinal conditions. SMI was defined as schizophrenia spectrum, mood, or anxiety disorders. The exposure was MHV within 30 days of discharge. The primary outcome was 30-day readmission. Secondary outcomes included emergency department presentation and psychiatric admission. Inverse probability weighting was used to evaluated outcomes.

Results: Of 88,092 analyzed patients, 11,755 (13.3%) had a MHV within 30 days of discharge. 23,696 (26.9%) of patients were managed operatively, 64,395 (73.1%) non-operatively. After adjustment for potential confounders, patients with a post-discharge MHV had lower odds of acute care readmission than patients without a MHV in both operative (OR 0.60; 95% CI: [0.40-0.90]) and non-operative (OR 0.67; 95% CI [0.53-0.84]) cohorts. There was no association between post-discharge MHV and ED presentation or psychiatric admission in the operative or non-operative groups.

Conclusions: Post-discharge MHV after EGS hospitalization was associated with decreased odds of readmission for patients with SMI managed operatively and nonoperatively. In older EGS patients with SMI, coordination of MHVs may be a mechanism to reduce readmission disparities.