Psychiatric illnesses before surgery associated with modest increased risk of death afterward

October 18, 2010

Individuals with co-occurring psychiatric illnesses, especially anxiety and depression, appear to have an increased risk of death within 30 days of surgery, according to a report in the October issue of Archives of Surgery.

Psychiatric illnesses occur along with physical complaints in an estimated 5 percent to 40 percent of hospitalized patients, according to background information in the article. Having a psychiatric condition is independently associated with an increased risk of illness and death. Previous studies of these conditions have largely been limited to patients admitted to the hospital for medical conditions, not surgical procedures.

Thad E. Abrams, M.D., M.S., of the Iowa City Veterans Affairs Medical Center and University of Iowa Carver College of Medicine, Iowa City, and colleagues studied 35,539 surgical patients admitted to intensive care units from Oct. 1, 2003, through Sept. 30, 2006. An existing psychiatric condition was identified in 8,922 (25.1 percent) of the patients, including 5,500 (15.5 percent) with depression, 2,913 (8.2 percent) with post-traumatic stress disorder, 2,473 (7 percent) with anxiety, 793 (2.2 percent) with bipolar disorder and 621 (1.8 percent) with psychosis.

Before adjustment, 30-day were similar among patients with and without psychiatric illnesses (3.8 percent vs. 4 percent). However, after the researchers considered other factors in their analyses, 30-day death rates were higher for patients with psychiatric conditions.

In individual analyses, the risk of dying within 30 days was associated with depression and anxiety, but not with any other psychiatric condition. In addition, 30-day death rates among those with were higher for those undergoing respiratory or procedures but not procedures involving the circulatory, nervous or .

"Several potential mechanisms exist to explain these findings," the authors write. "First, studies indicate that patients with depression frequently do not adhere to medical recommendations for underlying medical conditions. It is therefore plausible that such undertreated conditions may affect postoperative care and outcomes. Second, patients with existing psychiatric comorbidity may be more likely to undergo surgery by a lower-quality surgeon or hospital. Third, pre-existing psychiatric comorbidity may serve as an indicator for greater severity of surgical risk."

The results suggest greater care should be taken among patients with a psychiatric illness who are undergoing surgery, the authors note. "Until further research is completed, we recommend that surgeons caring for patients with a history of anxiety or depression seek early involvement of multidisciplinary teams to help identify problematic areas in perioperative care processes, particularly regarding issues of surgeon-patient communication and adherence to post-surgical recommendations."

More information: Arch Surg. 2010;145[10]:947-953.

Related Stories

Recommended for you

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.