Key result
Pre-existing serious mental illness was associated with a significantly lower likelihood of receiving major inpatient surgery after adjusting for demographics and comorbidities (adjusted ORs ranging from 0.24 to 0.31).
Why the study?
Does serious mental illness affect the likelihood of receiving major inpatient surgery in VA patients?
Cohort (n=7,150,127)
Yes
Does serious mental illness affect the likelihood of receiving major inpatient surgery in VA patients?
Effect estimate: OR 0.24-0.31 (95% CI 0.24-0.31)
Absolute Event Rate: 5.2% vs 4.5%
p-value: p=<0.0001
Patients with serious mental illness in the VA system are significantly less likely to undergo major inpatient surgery after adjusting for demographics and comorbidities.
May signal disparities in surgical access for serious mental illness; hypothesis-generating and requires prospective confirmation before practice implications.
BACKGROUND: The STOPP study (Surgical Treatment Outcomes for Patients with Psychiatric Disorders) analyzed variation in rates and types of major surgery by serious mental illness status among patients treated in the Veterans Health Administration (VA). VA patients are veterans of United States military service who qualify for federal care by reason of disability, special service experiences, or poverty. METHODS: STOPP conducted a secondary data analysis of medical record extracts for seven million VA patients treated Oct 2005-Sep 2009. The retrospective study aggregated inpatient surgery events, comorbid diagnoses, demographics, and postoperative 30-day mortality. RESULTS: Serious mental illness -- schizophrenia, bipolar disorder, posttraumatic stress disorder, or major depressive disorder, was identified in 12 % of VA patients. Over the 4-year study period, 321,131 patients (4.5 %) underwent surgery with same-day preoperative or immediate post-operative admission including14 % with serious mental illness. Surgery patients were older (64 vs. 61 years) and more commonly African-American, unmarried, impoverished, highly disabled (24 % vs 12 % were Priority 1), obese, with psychotic disorder (4.3 % vs 2.9 %). Among surgery patients, 3.7 % died within 30 days postop. After covariate adjustment, patients with pre-existing serious mental illness were relatively less likely to receive surgery (adjusted odds ratios 0.4-0.7). CONCLUSIONS: VA patients undergoing major surgery appeared, in models controlling for comorbidity and demographics, to disproportionately exclude those with serious mental illness. While VA preferentially treats the most economically and medically disadvantaged veterans, the surgery subpopulation may be especially ill, potentially warranting increased postoperative surveillance.
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Copeland et al. (2015) conducted a cohort in Veterans in the Veterans Health Administration system (n=7,150,127). Serious mental illness (schizophrenia, bipolar disorder, PTSD, or major depressive disorder) vs. No serious mental illness was evaluated on Receipt of major inpatient surgery (OR 0.24-0.31, 95% CI 0.24-0.31, p=<0.0001). Pre-existing serious mental illness was associated with a significantly lower likelihood of receiving major inpatient surgery after adjusting for demographics and comorbidities (adjusted ORs ranging from 0.24 to 0.31).
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