Influence of psychiatric comorbidity on surgical mortality.
ABSTRACT To examine the potential effect of 5 existing psychiatric comorbidities on postsurgical mortality.
Intensive care units of all Veterans Health Administration hospitals designated as providing acute care.
We studied 35 539 surgical patients admitted to intensive care units from October 1, 2003, through September 30, 2006.
Psychiatric comorbidity (depression, anxiety, posttraumatic stress disorder, bipolar disease, and schizophrenia) was identified using outpatient encounters in the 12 months preceding the index admission. End points included in-hospital and 30-day mortality. Generalized estimating equations accounted for hospital clustering and adjusted mortality for demographics, type of surgery, medical comorbidity, and disease severity.
We identified 8922 patients (25.1%) with an existing psychiatric comorbidity on admission. Unadjusted 30-day mortality rates were similar among patients with and without psychiatric comorbidity (3.8% vs 4.0%, P = .56). After adjustment, 30-day mortality was higher for patients with psychiatric comorbidity (odds ratio, 1.21; 95% confidence interval, 1.07-1.37; P = .003). In individual analyses, patients with depression and anxiety had higher odds of 30-day mortality (P = .01 and P = .02, respectively) but the odds were similar for the other conditions.
Existing psychiatric comorbidity was associated with a modest increased risk of death among postsurgical patients. Estimates of the increased risk across the individual conditions were highest for anxiety and depression. The higher mortality may reflect higher unmeasured severity or unique management issues in patients with psychiatric comorbidity.
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ABSTRACT: Objective The aim of this study was to quantify the effects of psychiatric disorders on major surgery outcomes and care resource use. Methods This study adopted a retrospective cohort study design. The samples consisted of hospital stays. Subjects were patients who had undergone major surgery. We used multilevel regression analysis to quantify the influence of psychiatric disorders on major surgery outcomes and care resource use. Results The total number of hospital stays included in the study was 5569, of which 250 were patients with psychiatric disorders. Compared with those without psychiatric disorders, those with schizophrenia had a significantly higher risk of complications, and those with neurotic disorder tended to have fewer complications. Total cost (TC) was significantly higher for those with schizophrenia and mood disorder and significantly lower in those with neurotic disorder. Lengths of stay (LOS) were significantly longer for those with schizophrenia and mood disorder but not for those with neurotic disorder. Postsurgical mortality was equivalent among those with any psychiatric disorder and among those without a psychiatric disorder. Conclusion The study revealed that surgical outcomes and care resource use are differentiated by psychiatric disorders.General Hospital Psychiatry 09/2014; · 2.90 Impact Factor
- Journal of Aging Science. 01/2013; 01(03).
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ABSTRACT: Breast cancer is a major health problem worldwide. The median survival duration for patients with metastatic breast cancer is two to three years. Approximately 1% of populations worldwide have schizophrenia. The manner in which schizophrenic patients fare when diagnosed with metastatic breast carcinoma (MBC) was evaluated. We queried the National Department of Veterans Affairs (DVA) datasets using computer codes for a pre-existing diagnosis of schizophrenia and a later diagnosis of breast carcinoma. Chart-based data concerning the identified subjects were then requested. Previously determined inclusion and exclusion criteria were applied to select evaluable patients from the medical records, prior to extracting demographic details and data concerning the treatment course in each subject. Ten patients had distant metastases at initial diagnosis, while seven developed MBC following prior curative-intent treatment. Two patients refused therapy. Ten did not comply with recommended management. Five harmed or threatened physicians, other caregivers or themselves. Schizophrenic patients with MBC often fail to understand the nature of their illnesses. Often they do not accept palliative treatment, while a number of them do not comply with therapy, once initiated. They often exhibit behaviors that are detrimental to themselves or others. Formal psychiatric consultation is therefore necessary in patients. Several detrimental behaviors may be predicted reliably by history alone.Molecular and Clinical Oncology 01/2013; 1(2):359-364.