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CC BY 4.0 · Arch Plast Surg 2024; 51(03): 304-310
DOI: 10.1055/a-2258-2438
Extremity/Lymphedema
Original Article

Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help

Holly D. Shan 
1   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Samuel S. Huffman 
1   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
2   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
,
John D. Bovill 
1   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Zoë K. Haffner 
1   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Parhom Towfighi 
1   Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
,
Carol D. Benedict 
3   Department of Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia
,
Karen K. Evans 
2   Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Abstract

Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS.

Methods Patients with HS were retrospectively identified at a single institution from 2010 to 2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey.

Results Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a preexisting psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1 ± 11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs. 1.5, p < 0.001), a higher median number of ED visits (1.0 vs. 0, p = 0.006), and a similar hospital length of stay (p = 0.456). The mean COST-FACIT score of the overall study population was 19.2 ± 10.7 (grade 1 financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p = 0.092) and reported greater financial hardship (3.3 vs. 1.7, p < 0.001). On multivariate analysis, a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries.

Conclusion Preexisting psychiatric conditions in patients with HS are associated with increased health care utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.

Keywords

hidradenitis suppurativa - anxiety - depression - psychiatric comorbidities - financial stress

Authors' Contributions

All authors made contributions to study conception, drafting of the article, critically revising the article for appropriate intellectual content, and approving the final version.


Ethical Approval

IRB approved my Medstar Georgetown University Hospital STUDY00004407.


Patient Consent

Consent was given by all patients prior to the administration of COST-FACIT surey.


Supplementary Material



Publication History

Received: 03 January 2023

Accepted: 26 August 2023

Accepted Manuscript online:
31 January 2024

Article published online:
04 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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