Clinical Scorecard: Impact of Preoperative Mental Health Conditions on Healthcare Utilization Following Metabolic Bariatric Surgery: A Retrospective Analysis

At a Glance

Key Highlights

• Prevalence of mental disorders in MBS patients is approximately 23%, with depressive and binge eating disorders most common
• Postoperative GI complaints and pain are frequent and may be exacerbated by preoperative mental disorders
• Preoperative mental disorders are associated with increased non-routine healthcare use, particularly GI-related appointments and emergency visits within the first postoperative year

Guideline-Based Recommendations

Diagnosis

• Conduct structured preoperative psychological assessments using DSM-5 based semi-structured interviews to identify mental disorders
• Screen for depressive disorders, anxiety disorders, eating disorders, and other relevant mental health conditions prior to MBS

Management

• Consider integrated care approaches addressing both mental health and physical symptoms to optimize postoperative outcomes
• Tailor postoperative support programs to patients’ mental health status to potentially reduce non-routine healthcare utilization

Monitoring & Follow-up

• Monitor postoperative GI symptoms and pain closely in patients with preoperative mental disorders
• Track non-routine healthcare appointments and emergency visits as indicators of postoperative complications or unmet needs

Risks

• Patients with preoperative mental disorders may have higher risk of postoperative GI complaints and pain
• Increased healthcare utilization may reflect more complex postoperative recovery and require multidisciplinary management

Patient & Prescribing Data

Adults undergoing primary metabolic bariatric surgery with or without preoperative mental disorders

Preoperative mental health status influences postoperative healthcare use patterns, suggesting the need for personalized postoperative care strategies

Clinical Best Practices

• Perform comprehensive preoperative mental health evaluations using DSM-5 criteria
• Exclude routine psychologist appointments from healthcare utilization metrics to avoid bias in assessing non-routine care
• Use negative binomial regression models to analyze healthcare utilization data accounting for excess zero counts in GI-related visits
• Adjust for confounders such as age, gender, surgery type, BMI, comorbidities, and smoking status in outcome analyses

References

• Prevalence of mental disorders in MBS patients
• Association of depression and anxiety with postoperative pain
• GI symptoms and mental health in general populations
• DSM-5 diagnostic criteria