Postoperative complications in the seriously mentally ill: A systematic review of the literature

Laurel A. Copeland, John E. Zeber, Mary Jo Pugh, Eric M. Mortensen, Marcos I. Restrepo, Valerie A. Lawrence

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

To determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness. BACKGROUND:: Despite a burgeoning literature during the last 20 years regarding perioperative risk management, little is known about intraoperative and postoperative complications among patients with schizophrenia and other serious mental illnesses. METHODS:: A systematic literature search of Medline (1966-August 2007) and review of studies was conducted. Eligible studies were of any design with at least 10 patients diagnosed with serious mental illness, reporting perioperative medical, surgical, or psychiatric complications. RESULTS:: The search identified 1367 potentially relevant publications; only 12 met eligibility criteria. Of 10 studies of patients with schizophrenia, 9 had fewer than 100 patients, whereas one large retrospective study reported higher rates of postoperative complications among 466 schizophrenia patients compared with 338,257 controls. These studies suggest that patients with schizophrenia, compared with those without mental illness, may have higher pain thresholds, higher rates of death and postoperative complications, and differential outcomes (eg, confusion, ileus) by anesthetic technique. Two studies evaluated outcomes in patients with major depressive disorder and found higher rates of postoperative delirium and postoperative confusion. Both schizophrenia and depression patients experienced more postoperative confusion or delirium when psychiatric medications were discontinued preoperatively. We identified no studies of perioperative outcomes in patients with bipolar or posttraumatic stress disorder. CONCLUSIONS:: There are few studies of perioperative outcomes in patients with serious mental illness. Future research should assess surgical risks among patients with serious psychiatric conditions using rigorous methods and well-defined clinical outcomes.

Original languageEnglish (US)
Pages (from-to)31-38
Number of pages8
JournalAnnals of Surgery
Volume248
Issue number1
DOIs
StatePublished - Jul 2008

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Mentally Ill Persons
Schizophrenia
Confusion
Psychiatry
Delirium
Outcome Assessment (Health Care)
Pain Threshold
Knowledge Bases
Ileus
Intraoperative Complications
Major Depressive Disorder
Risk Management
Post-Traumatic Stress Disorders
Anesthetics
Publications
Retrospective Studies
Depression

ASJC Scopus subject areas

  • Surgery

Cite this

Postoperative complications in the seriously mentally ill : A systematic review of the literature. / Copeland, Laurel A.; Zeber, John E.; Pugh, Mary Jo; Mortensen, Eric M.; Restrepo, Marcos I.; Lawrence, Valerie A.

In: Annals of Surgery, Vol. 248, No. 1, 07.2008, p. 31-38.

Research output: Contribution to journalArticle

Copeland, Laurel A. ; Zeber, John E. ; Pugh, Mary Jo ; Mortensen, Eric M. ; Restrepo, Marcos I. ; Lawrence, Valerie A. / Postoperative complications in the seriously mentally ill : A systematic review of the literature. In: Annals of Surgery. 2008 ; Vol. 248, No. 1. pp. 31-38.
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