Serious mental illness complicates surgical outcomes

PEOPLE with serious mental illness have higher rates of post-operative complications and longer stays in hospital, according to a systematic review published by the MJA.

Kate McBride, Director of the Institute of Academic Surgery at Royal Prince Alfred Hospital and PhD candidate at the University of Sydney, and colleagues reviewed 26 international studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery.

“We found that several poorer surgical outcomes were more likely for people with serious mental illnesses than for other patients, including greater risk of post-operative complications, longer stays in hospital, higher inpatient costs, and greater risk of re-admissions within 30 days of discharge,” McBride and colleagues wrote.

“Rates of in-hospital or 30-day death were similar for patients with or without serious mental illness, but these events are generally rare (0.08% of all surgical patients).

“Further, our findings suggest that surgical patients with serious mental illness probably stay in hospital longer because of post-operative complications rather than behavioural disturbances or other confounders linked to their mental illness diagnosis, including medical comorbidity.

“With the exception of pain in patients with schizophrenia, we identified no surgical outcome for which outcomes were better for patients with serious mental illness than for patients without such illnesses.”

McBride and colleagues suggested that there were opportunities for optimising surgical outcomes for patients with serious mental illnesses, “including testing a range of interventions, such as pre-surgery screening tools, collaborative care models that enhance communication between and linkage of surgical and mental health teams, and improving awareness in inpatient clinical teams of the needs of patients with serious mental illness”.

“Associations between post-operative surgical outcomes and specific serious mental illness diagnoses should also be investigated, including substance misuse and eating disorder diagnoses, data for which are not currently available,” they concluded.

Also online first at the MJA

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