Vascular surgery receipt and outcomes for people with serious mental illnesses: Retrospective cohort study using a large mental healthcare database in South London

Ghani, Marvey; Kuruppu, Sajini; Pritchard, Megan; Harris, Matthew; Weerakkody, Ruwan; Stewart, Robert; Perera, Gayan

doi:10.1016/j.jpsychores.2021.110511

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…We found substantially elevated rates of gastrointestinal, cardiovascular and respiratory procedures, which may reflect a higher prevalence of cardiac, metabolic, alcohol-related or smoking-related conditions in people living with mental ill health (Firth et al , 2019 ). The findings are consistent with studies showing higher rates of cardiovascular procedures in people with serious mental illness (Brooks et al , 2022 ; Ghani et al , 2021 ).…”

Section: Discussionsupporting

confidence: 91%

“…A handful of studies have examined a broader range of surgical procedures in MH cohorts, finding higher rates for some procedures. In South London, people receiving MH care were 40–80% more likely to have emergency cardiac (Brooks et al , 2022 ) or vascular surgery (Ghani et al , 2021 ). US veterans with MH diagnoses had higher rates of emergency procedures such as partial amputations (Copeland et al , 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users

Sara,

Hamer,

Gould

et al. 2024

Epidemiol Psychiatr Sci

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Aims Timely access to surgery is an essential part of healthcare. People living with mental health (MH) conditions may have higher rates of chronic illness requiring surgical care but also face barriers to care. There is limited evidence about whether unequal surgical access contributes to health inequalities in this group. Methods We examined 1.22 million surgical procedures in public and private hospitals in New South Wales (NSW), Australia, in 2019. In a cross-sectional study of 76,320 MH service users aged 18 and over, surgical procedure rates per 1,000 population were compared to rates for 6.23 million other NSW residents after direct standardisation for age, sex and socio-economic disadvantage. Rates were calculated for planned and emergency surgery, for major specialty groups, for the top 10 procedure blocks in each specialty group and for 13 access-sensitive procedures. Subgroup analyses were conducted for hospital and insurance type and for people with severe or persistent MH conditions. Results MH service users had higher rates of surgical procedures (adjusted incidence rate ratio [aIRR]: 1.53, 95% CI: 1.51–1.56), due to slightly higher planned procedure rates (aIRR: 1.22, 95% CI: 1.19–1.24) and substantially higher emergency procedure rates (aIRR: 3.60, 95% CI: 3.51–3.70). Emergency procedure rates were increased in all block groups with sufficient numbers for standardisation. MH service users had very high rates (aIRR > 4.5) of emergency cardiovascular, skin and plastics and respiratory procedures, higher rates of planned coronary artery bypass grafting, coronary angiography and cholecystectomy but lower rates of planned ophthalmic surgery, cataract repair, shoulder reconstruction, knee replacement and some plastic surgery procedures. Conclusions Higher rates of surgery in MH service users may reflect a higher prevalence of conditions requiring surgical care, including cardiac, metabolic, alcohol-related or smoking-related conditions. The striking increase in emergency surgery rates suggests that this need may not be being met, particularly for chronic and disabling conditions which are often treated by planned surgery in private hospital settings in the Australian health system. A higher proportion of emergency surgery may have serious personal and health system consequences.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users

Sara,

Hamer,

Gould

et al. 2024

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

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“…Previous studies, including our own work, have suggested that postoperative surgical outcomes are commonly worse in patients with mental health problems [ 10 , 11 ]. They may therefore constitute a potentially high-risk group for adverse outcomes after cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

“…They may therefore constitute a potentially high-risk group for adverse outcomes after cardiac surgery. A better understanding of postoperative outcomes in this group would lead to more effective treatment and play a key role in managing cardiovascular disease [ 10 ], as well as contributing to understanding of broader health inequalities experienced.…”

Section: Introductionmentioning

confidence: 99%

Cardiac surgery receipt and outcomes for people using secondary mental healthcare services: Retrospective cohort study using a large mental healthcare database in South London

et al. 2022

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Background.Patients with diagnosed mental health problems are more predisposed to cardiovascular disease, including cardiac surgery. Nevertheless, health outcomes after cardiac surgery for patients with mental health problems as a discrete group are unknown. This study examined the association between secondary care mental health service use and postoperative health outcomes following cardiac surgery. Methods.We conducted a retrospective observational research, utilising data from a large South London mental healthcare supplier linked to national hospitalisation data. OPCS-4 codes were applied to classify cardiac surgery. Health results were compared between those individuals with a mental health disorder diagnosis from secondary care and other local residents, including the length of hospital stay (LOS), inpatient mortality, and 30-day emergency hospital readmission. Results.12,384 patients received cardiac surgery, including 1,481 with a mental disorder diagnosis.Patients with mental health diagnosis were at greater risk of emergency admissions for cardiac surgery (Odds ratio [

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“… 32 , 33 Similarly, the household composition and disability subtheme encompasses multiple factors that are associated with poor surgical outcomes, such as patients at the extremes of age 34 , 35 or those individuals who have a disability. 36 , 37 …”

Section: Discussionmentioning

confidence: 99%

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

Labiner

Hyer

Cloyd

et al. 2022

Journal of Gastrointestinal Surgery

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Background There has been increased interest in understanding how social determinants of health (SDH) may affect care both in the medical and surgical setting. We sought to define the impact of various aspects of social vulnerability on the ability of patients to achieve a “textbook outcome” (TO) following hepatopancreatic surgery. Methods Medicare beneficiaries who underwent hepatopancreatic resection between 2013 and 2017 were identified using the Medicare database. Social vulnerability was defined using the Centers for Disease Control Social Vulnerability Index (SVI), which is comprised of four subthemes: socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). TO was defined as the composite endpoint: absence of 90-day mortality or readmission, absence of an extended length of stay (LOS), and no complications during the index admission. Cluster analysis was used to identify vulnerability cohorts, and multivariable logistic regression was utilized to assess the impact of these SVI subthemes on the likelihood to achieve a textbook outcome. Results Among 37,707 Medicare beneficiaries, 64.9% ( n = 24,462) of patients underwent pancreatic resection while 35.1% ( n = 13,245) underwent hepatic resection. Median patient age was 72 years (IQR: 68–77), just over one-half were male (51.9%; n = 19,558), and the median CCI was 3 (IQR: 2–8). Cluster analysis revealed five distinct SVI profiles with wide variability in the distribution of SVI subthemes, ranging from 15 (profile 1 IQR: 7–26) to 83 (profile 5 IQR: 66–93). The five profiles were grouped into 3 categories based on median composite SVI: “low vulnerability” (profile 1), “average vulnerability” (profiles 2 and 3), or “high vulnerability” (profiles 4 and 5). The rate of TO ranged from 44.6% in profile 5 ( n = 4022) to 49.2% in profile 1 ( n = 4836). Multivariable analyses comparing patients categorized into the two average SVI profiles revealed that despite having similar composite SVI scores, the risk of adverse postoperative outcomes was not similar. Specifically, patients from profile 5 had lower odds of achieving a TO (OR 0.89, 95%CI: 0.83–0.95) and higher odds of 90-day mortality (OR 1.29, 95%CI: 1.15–1.44) versus patients in profile 4. Conclusion Distinct profiles of SVI subtheme characteristics were independently associated with postoperative outcomes among Medicare beneficiaries undergoing HP surgery, even among patients with similar overall composite SVI scores. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-022-05245-9.

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Vascular surgery receipt and outcomes for people with serious mental illnesses: Retrospective cohort study using a large mental healthcare database in South London

Cited by 7 publications

References 51 publications

Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users

Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users

Cardiac surgery receipt and outcomes for people using secondary mental healthcare services: Retrospective cohort study using a large mental healthcare database in South London

Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery

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