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Zeber JE (VERDICT), Copeland LA
(VERDICT), Lawrence VA
(VERDICT), Hosek BJ
(VERDICT), Pugh MJ
(VERDICT)
Objectives:
Veterans with serious mental illness (SMI) have substantially greater healthcare needs, self-help skills, more frequent homelessness and disengagement from care preventing early diagnosis and treatment. Disorganized thinking impairs recognition and communication of serious symptoms, leading to delayed surgical intervention and increased post-operative complications. These factors combine with increased mortality risks from cardiovascular, digestive, and respiratory illnesses to shorten life expectancy by an estimated 25-30 years. Recognizing a major literature gap regarding surgical experiences of SMI patients, we examined the association between psychiatric diagnosis and the prevalence of preoperative comorbidities.
Methods:
Veterans with diagnoses of schizophrenia, bipolar disorder, or post-traumatic stress disorder (PTSD) in FY05 were identified in national VA data. Surgical patients were defined by procedures in the VA's National Surgical Quality Improvement Program (NSQIP), confirmed by a perioperative expert. Analyses compared age-adjusted prevalence rates of comorbid conditions across the three SMI groups.
Results:
The national population of SMI patients meeting inclusion criteria was 376,179, of whom 14,491 had at least one NSQIP surgical procedure (3.9%). The study cohort consisted of 3,209 patents with schizophrenia, 2,440 with bipolar, and 8,842 with PTSD. Veterans with schizophrenia experienced more diabetes (32%) and heart failure, while bipolar patients had more COPD diagnoses. However, PTSD patients experienced the overall highest burden of comorbidities, with significantly elevated rates on 15 of 23 different chronic, acute, and pain conditions compared to schizophrenia and bipolar. Of particular significance, cardiovascular disease (32%), depression (53%), hyperlipidemia (52%), and pain conditions (51%) exceeded the rates of 20%, 25%, 35%, and 24% seen in schizophrenia, and 25%, 39%, 44%, and 39% in bipolar patients (all p < .001).
Implications:
Although SMI patients shared high prevalence of comorbidities, veterans with PTSD experienced greater rates across a spectrum of serious conditions. Prevalence findings here far exceed published NSQIP data in non-psychiatric surgical veterans (e.g., diabetes 21%). The challenging nexus of PTSD, depression, pain, and physical comorbidities requires a heightened recognition in providers responsible for an aging population of SMI surgical patients.
Impacts:
The intersection of debilitating comorbidities and preoperative psychiatric disease, information currently not available in NSQIP, will allow providers to better monitor patients with chronic conditions necessitating future surgical needs.
