Perioperative complications of emergent and elective procedures in psychiatric patients

Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta‐analysis

“…The included studies covered a range of surgical specialties: mixed specialties (585 930 patients in total), 17,20,22,28,29,31,40 and orthopaedic (5 383 241 patients), 18,21,23,27,32,37 colorectal or gastrointestinal (24 801 patients), 19,25,26,41 cardiothoracic or vascular (611 patients), [34][35][36][37][38] bariatric (21 405 patients), 30,33 breast (40 251 patients), 24,39 and plastic surgery (116 597 patients); 42 a total of 6 129 806 unique patients were included. Study sample sizes ranged between 21 34 and 5 339 284 patients.…”

“…Serious mental illness was diagnosed with an objective measure (eg, ICD diagnosis codes) or by a psychiatrist in 19 studies; in seven studies, it was determined with a validated patient self-report instrument. The investigated diagnoses were any serious mental illness, 17,19,[24][25][26]28,30,31,34,41,42 depression, 17,18,[20][21][22]25,32,33,[35][36][37]39,40 anxiety, 17,23,32,35,38,39,41 schizophrenia, 22,25,27,29,31,32 bipolar disorder, 17,22 and PTSD 17,22 (Supporting Information, table 2).…”

“…Overall risk of bias was low in eighteen studies. 17,[20][21][22][24][25][26][29][30][31][32][33][36][37][38][40][41][42] Five studies were assessed as having a moderate risk of bias because of problems with study participation, outcome measurements, confounding, or poor statistical analysis. 18,19,23,28,35 Three studies were assessed as having a high risk of overall bias because of problems with study attrition, prognostic measures, confounding, or statistical analysis.…”

“…18,19,23,28,35 Three studies were assessed as having a high risk of overall bias because of problems with study attrition, prognostic measures, confounding, or statistical analysis. 27,34,39 Risk of study confounding was low in 20 studies that measured and adjusted for key confounders, such as age, sex, ethnic background, and comorbid medical conditions that can affect surgical outcomes 17,18,[20][21][22][24][25][26][28][29][30][31][32][33][36][37][38][40][41][42] (Supporting Information, table 3).…”

“…The association between having any serious mental illness diagnosis and having any post-operative complication (ten studies, 125 624 patients) was statistically significant 19,[24][25][26]28,29,31,33,37,41 (pooled effect: OR, 1.44; 95% CI, 1.15-1.79) (Box 1). Restricting analysis to studies that used objective measures for determining serious mental illness diagnoses (eight studies, 115 704 patients) 19,[24][25][26]28,29,31,41 yielded a similar result (pooled effect: OR, 1.41; 95% CI, 1.11-1.79).…”