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

Abstract

atients with serious mental illness who require surgical care are routinely treated in non-psychiatric hospitals. 1 As the prevalence of serious mental illness is relatively low (2-3% in Australia 2 ), it is unsurprising that surgeons only infrequently ask patients about their mental health before operations, and lack confidence in caring for these vulnerable and complex patients. 3 Serious mental illness should be treated like any other medical comorbidity and managed pro-actively, both before and after surgery, to optimise the patient's care. This ideal is realised for some surgery types, such as solid organ transplantation and bariatric surgery, 4,5 but established care pathways for patients undergoing routine surgical treatment are rare. Further, patients with serious mental illnesses have a higher burden of chronic disease, 6 experience negative attitudes from a range of health professionals, 7-11 and may find navigating complex health systems difficult. 12,13 Several studies have investigated surgical outcomes for people with serious mental illness, but there have been few reviews; findings with regard to relative mortality and morbidity have been mixed, and the overall risk for these vulnerable patients is unclear. The aim of our systematic review and meta-analysis was to develop a greater understanding of the association between having a serious mental illness and outcomes of elective surgery for adults, including in-hospital and 30-day mortality, hospital re-admission, post-operative complications, and hospital length of stay. MethodsWe employed the methods recommended by the Cochrane Methods Prognosis Group 14 and our review protocol concords with the PRISMA-P statement 15 (PROSPERO registration, CRD42018080114; 30 January 2018).

Risk Assessment of Postoperative Pneumonia in Cancer Patients Using a Common Data Model

“…To our knowledge, no published study has identified mood disorder as a risk factor for pneumonia after cancer surgery. In general, patients with mental illness are at an increased risk of various postoperative complications, including pneumonia [ 28 ]. Patients with severe mental illness are more likely to have poor insight into their overall health and difficulty in self-care, which can negatively affect hygiene [ 29 ].…”

Gut microbiota-mediated metabolic restructuring aggravates emotional deficits after anesthesia/surgery in rats with preoperative stress

“…Postoperative mental condition for patients is significantly correlated with physical outcomes and can dramatically influence the quality of life, thus leading to public health concerns ( 1 , 2 ). Individuals with preoperative stress are prone to postoperative emotional deficits, especially adolescent patients ( 3 ).…”

More (Good) Psychiatry

“…Depression, common in the postoperative setting, makes it especially challenging to perform healthy behaviors and thus predicts worse weight loss outcomes following bariatric surgery. Broadly speaking, serious mental illness increases the odds of postoperative complications and longer hospital stays [3].…”