LAUSR

BACKGROUND Psychiatric comorbidity is associated with greater 30-day postoperative complication rates in various surgical specialties, but is not well characterized for reconstructive plastic surgery. OBJECTIVE To compare reconstructive plastic surgery rates and 30-day postoperative complications between patients with and without psychiatric diagnoses. METHODS Retrospective cohort study comparing patients with and without psychiatric diagnoses. Data were collected from the IBM® MarketScan® Commercial and Medicare Supplemental Databases between January 1, 2007 and December 31, 2015. Rates of reconstructive plastic surgery, demographic data, covariant diagnoses, and 30-day postoperative complications were collected. Multivariable logistic regression assessed differences between the two groups. RESULTS Of 1,019,128 patients (505,715 with psychiatric diagnoses and 513,423 without psychiatric diagnoses) assessed, reconstructive plastic surgery rates were between 4.8-7.0% in those with psychiatric diagnoses, compared to 1.6% in patients without psychiatric diagnoses. The greatest odds of undergoing reconstructive plastic surgery were in patients with BDD (aOR 3.16; 95% CI 1.76-5.67), and anxiety disorder (aOR 3.08; 95% CI 2.97-3.17). When assessing 1,234,206 patients (613,400 with psychiatric diagnoses and 620,806 without psychiatric diagnoses) all of whom underwent reconstructive plastic surgery, two-fold greater odds of any 30-day postoperative complication was associated with psychiatric diagnoses (aOR 2.01; 95% CI 1.28-3.11), as well as greater odds of specific complications (surgical site infection, bleeding, and hospital admission). Of all factors assessed, eating disorder diagnosis was associated with the greatest odds of a complication (aOR 4.17; 95% CI 3.59-4.86), followed by nasal surgery (aOR 3.65; 95% CI 2.74-4.89), and BDD (aOR 3.16; 95% CI 1.76-5.67). CONCLUSIONS Diagnosis of a psychiatric condition is associated with greater rates of reconstructive plastic surgery, and two-fold greater odds of 30-day postoperative complications.