Zeber JE (REAP San Antonio), Mortensen EM
(REAP San Antonio), Restrepo MI
(REAP San Antonio), Pugh MJ
(REAP San Antonio), Copeland LA
(REAP San Antonio)
Despite a burgeoning literature over the last 20 years regarding perioperative risk management, little is known about intraoperative and postoperative complications among patients with diagnosed schizophrenia or other serious mental illness. Therefore, we sought to determine the knowledge base concerning clinical outcomes of surgery among persons diagnosed with schizophrenia, bipolar disorder, post-traumatic stress disorder, or major depressive disorder.
Systematic search of Medline (1966-August 2007). Eligible studies were those of any design with at least 10 patients diagnosed with a serious mental illness, reporting perioperative medical, surgical, or psychiatric complications.
The search identified 1,367 potentially relevant publications; however, only 12 met eligibility criteria. Of 10 studies examining patients with schizophrenia, 9 had fewer than 100 patients while one large retrospective study found higher rates of postoperative complications among 466 surgery patients with schizophrenia. These studies suggest that patients with schizophrenia, compared to those without mental illness, may have higher pain thresholds, higher rates of death and postoperative complications, as well as differential outcomes by anesthetic technique (e.g., confusion, postoperative ileus). Two studies evaluated outcomes in patients diagnosed with major depressive disorder and found higher rates of postoperative delirium and postoperative confusion relative to controls. Both schizophrenia and major depression patients experienced more postoperative confusion/delirium when psychiatric medications were discontinued preoperatively. We found no eligible studies of perioperative outcomes in patients with bipolar or post-traumatic stress disorder.
There are few studies of perioperative outcomes in patients with serious mental illness. Given high prevalence rates, future research should assess surgical risk among patients with serious psychiatric conditions using large samples and a wide array of clinical outcomes.
Although the National Surgical Quality Improvement Program provides the usual means for assessing the quality of surgery outcomes among VA patients, its lack of pre-surgical psychiatric diagnoses precludes study of the half million VA patients with one of the serious mental illnesses we examined. These patients may experience unexpectedly high rates of complications, a risk of which their treating clinicians should be apprised. Our research group is currently assessing rates of complications among VA patients with and without serious mental illness.