Patients with schizophrenia or depression may be more prone to postoperative complications than patients without mental illness, according to a review of the literature — such as it is.
"The knowledge base on clinical outcomes of surgery for patients with comorbid serious mental illness is extremely small, although we know the mentally ill carry a heavy burden in terms of comorbid medical disease," Dr. Laurel A. Copeland told Reuters Health.
Dr. Copeland, of the University of Texas Health Science Center, San Antonio, and colleagues conducted a systematic literature search of Medline for studies on the topic. Eligible studies included those with at least 10 patients diagnosed with serious mental illnesses, including schizophrenia, bipolar disorder, major depressive disorder, and post-traumatic stress disorder. The studies reported perioperative medical, surgical, or psychiatric complications.
As reported in the July issue of the Annals of Surgery, 1367 potentially relevant publications were identified but only 12 met eligibility criteria.
Based on the pooled data, the investigators found that compared to patients without mental illness, those with schizophrenia may have higher pain thresholds and higher rates of death and postoperative complications. In addition, schizophrenic patients may experience higher rates of complications from certain anesthetic techniques.
Patients with major depressive disorder had higher rates of postoperative delirium and postoperative confusion.
When psychiatric medications were discontinued preoperatively, patients with schizophrenia and depression experienced more postoperative confusion or delirium.
No studies of perioperative outcomes in patients with bipolar disorder or post-traumatic stress disorder were identified.
"Surgeons may not have sufficient information on how patients with serious mental illness differ from other patients in terms of stage of illness at presentation, medication needs during and after surgery, and post-operative care needs," Dr. Copeland pointed out.
However, "We have received grant funding from the Department of Veterans Affairs for a nationwide study of surgery types, surgery rates, and post-operative complications in the VA, comparing patients with and without serious mental illness," Dr. Copeland continued.
"Using the types of surgeries tracked by the National Surgical Quality Improvement Program (NSQIP), we are currently analyzing data from the VA's electronic medical records system on nearly half a million mentally ill patients, including patients with schizophrenia, bipolar disorder, post-traumatic stress disorder, or other psychosis," she explained.
"This topic cannot be studied using NSQIP data, which do not include psychiatric comorbidity measures," Dr. Copeland noted. "Our database, however, is rich with detail regarding pre-operative conditions and post-operative complications."
Ann Surg 2008;248:31-38.
Reviewed by Ramaz Mitaishvili, MD
