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Updated 16 February 2013

Schizophrenics may fare worse after surgery

Surgical patients with schizophrenia have more postoperative complications and a nearly three-fold higher risk of 30-day mortality than patients without mental disorders.

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Surgical patients with schizophrenia have more postoperative complications and a nearly three-fold higher risk of 30-day mortality than patients without mental disorders, a new study finds.

The researchers say their observations from a population-based cross-sectional study have "important clinical implications, both for their predictive value and for showing the urgent need to improve management of surgical patients with schizophrenia."

Using the Taiwan National Health Insurance Research Database, Dr Ta-Liang Chen from Taipei Medical University Hospital and colleagues identified 8 967 schizophrenic patients who had major surgery between 2004 and 2007 and 35 868 surgical patients without mental disorders.

In an article online December 13 in Annals of Surgery, they report that patients with schizophrenia were more likely to have coexisting medical conditions including chronic obstructive pulmonary disease (10.8% vs 7.6%, p<0.0001), diabetes (10.6% vs 8.4%, p<0.0001), and stroke (2.9% vs 1.7%, p<0.0001).

They also had higher rates of complications after surgery, including stroke (2.6% vs 1.9%, p<0.0001), bleeding (1.6% vs 1.2%, p=0.0022), pneumonia (1.3% vs 0.4%, p<0.0001), septicaemia (0.8% vs 0.3%, p<0.0001), and acute renal failure (0.3% vs 0.1%, p=0.0005).

The overall postoperative complication rate was also significantly higher in the schizophrenia group (6.2% vs 3.9%, p<0.0001).

The patients with schizophrenia spent more time hospitalised (24.9 vs 9.5 days, p<0.0001) and in the intensive care unit (17.1% vs 11.1%, p<0.0001) and were more likely to die in the first month after surgery (1.1% vs 0.4%, p<0.0001), the researchers say.

What the study found

After adjusting for sex, age, types of surgery and anaesthesia, whether the operation had been performed in a teaching hospital or not, and pre-existing medical conditions, schizophrenic surgical patients had significantly higher risk of postoperative mortality (odds ratio 2.70) and major complications including acute renal failure (OR 3.92), pneumonia (OR 2.99), septicaemia (OR 2.83), stroke (OR 1.39), and postoperative bleeding (OR 1.27).

The researchers also saw positive correlations between 30-day postoperative mortality and the frequency of preoperative schizophrenia-related outpatient visits, history of hospitalisation, or use of emergency services owing to main diagnosis of schizophrenia.

"To our best knowledge," they say, "this study is the first to validate the potential association of clinical severity of schizophrenia with 30-day postoperative mortality among surgical patients." The severity of schizophrenia and pattern of medical utility preoperatively "plays an important clinical role in predicting patients' postoperative mortality before surgery," they add.

They believe that better preoperative assessment and prevention could reduce the risk of poor outcomes after surgery in schizophrenic patients.

In an email, Dr Chen said, "With the understanding of the risk factors for higher postoperative complication and mortality rates in schizophrenic patients, the surgical team may anticipate and provide early diagnosis and treatment for this specific population."

In addition, "health care personnel should be specifically educated and keep a vigilant eye on potential overdosing, under dosing, or interactions between analgesics, anaesthetics, and psychotropic medications for schizophrenic patients to prevent the potential postoperative adverse outcomes," Dr Chen advised. "Psychiatrists should be routinely included, working as an integrated surgical health care team to provide professional knowledge for patients with mental illness."

(Reuters Health, January 2013)

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