The Impact of Psychiatric Comorbidities on Outcomes and Quality of Life in Plastic Surgery: A Literature Review and Matched Analysis.

[BACKGROUND] Patients undergoing plastic surgery have higher rates of psychiatric disorders, which can influence surgical outcomes and quality of life (QoL).

[METHODS] A retrospective review was conducted of patients with or without psychiatric comorbidities who underwent reduction mammaplasty or body contouring (panniculectomy or abdominoplasty) from 2016 through 2022. Propensity score matching accounted for age, body mass index (BMI), race and ethnicity, bariatric surgery history, ptosis, and breast tissue mass. Demographics, clinical characteristics, and postoperative outcomes were compared. QoL was assessed using preoperative and postoperative BREAST-Q and BODY-Q scores. A literature review using PubMed, MEDLINE, Embase, Scopus, and Cochrane databases was performed to evaluate surgical outcomes of patients with psychiatric disorders undergoing plastic surgery.

[RESULTS] Among 554 patients, 194 underwent body contouring (97 with and 97 without psychiatric diagnoses) and 360 underwent reduction mammoplasty (180 with and 180 without psychiatric diagnoses). Body contouring patients had an average age of 46.7 years and BMI of 31.2. Psychiatric comorbidities were linked to increased surgical site occurrences (adjusted odds ratio [AOR] 3.02) and longer hospital stays (AOR 1.73). Reduction mammaplasty patients had an average age of 36.3 years and BMI of 29.7. Psychiatric comorbidities predicted more readmissions and emergency department visits (AOR 4.86). Both groups showed improved postoperative QoL regardless of psychiatric status. All 7 studies included in the literature review reported higher complication rates in patients with psychiatric diagnoses.

[CONCLUSIONS] Psychiatric comorbidities are associated with higher complication rates and health care utilization in plastic surgery. Nonetheless, these patients have comparable postoperative QoL improvement, underscoring the benefit of these procedures. Appropriate preoperative or postoperative interventions should be considered to optimize outcomes and satisfaction in this vulnerable patient population.