Postoperative Complications in Mentally Ill

The authors of this systematic review included only the serious mental illness of schizophrenia, bipolar disorder, major depressive disorder (MDD), and posttraumatic stress disorder (PTSD). As if the other mental illnesses are not serious?

Well lets stop moaning their initiative is praiseworthy. They performed a systematic literature search of Medline (1966–August 2007) and a review of the studies was conducted to determine the knowledge base on clinical outcomes of surgery among persons diagnosed with serious mental illness.

After selection they found 10 articles reporting perioperative medical, surgical, or psychiatric complications with schizophrenia and 2 for depression.
Patients with schizophrenia undergoing surgery were reported in 2 Case series, 4 Cohort studies and 4 Randomized controlled trials. For depression their were 2 cohort studies.

Conclusions

• a very limited knowledge base regarding postoperative clinical complications and perioperative risk management among patients previously diagnosed with serious mental illness
• patients with schizophrenia undergoing elective and emergency operations may have more advanced surgical disease at presentation
• patients with schizophrenia have higher postoperative complication rates
• patients with schizophrenia have a deteriorating psychiatric status if psychotropic medications are discontinued preoperatively, and increased postoperative mortality
• patients with schizophrenia have reduced pain perception may impair or delay patients’ ability to report symptoms of postoperative infection
• psychiatric patients usually have several different kind of medications especially elderly
• for those with substance abuse disorders in remission, clinicians are presented with the challenge of managing postoperative pain without exacerbating or reactivating addiction
• increased rates of delirium and confusion in the postoperative period have been reported in patients with schizophrenia. Delirium is associated with higher mortality, longer hospital stay, and impairment at hospital discharge
• their deficits in self-care and engagement in unhealthy lifestyle behaviors are well documented suggesting that adverse sequelae of surgery may be especially problematic for this group
• psychiatric patients have high rates of cardiovascular, gastrointestinal, and respiratory
  illness

Implications

• psychiatric medications should be continued, if possible, during the perioperative period
• much more research is needed regarding anesthetic and analgesic care and other issues of perioperative risk management to reduce complications
• because there is evidence of increased postoperative complications in patients with serious mental illness, and given schizophrenia patients’ risk for cardiac irregularities, obesity, and respiratory disorders it also seems advisable to involve psychiatric consultation services in perioperative management of these patients

It seems advisable to involve psychiatric consultation services, that is to me the most important implication of this systematic review, what do you think?
Are the mentally ill neglected during the perioperative period? Let me know in the comments.

Laurel A. Copeland, John E. Zeber, Mary Jo Pugh, Eric M. Mortensen, Marcos I. Restrepo, Valerie A. Lawrence (2008). Postoperative Complications in the Seriously Mentally Ill
A Systematic Review of the Literature Annals of Surgery, 248 (1), 31-38 DOI: 18580204