HSR&D Citation Abstract
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Epidemiology of Three Common Surgeries in Veterans with Schizophrenia
Copeland LA, Zeber JE, Sako EY, Flynn J, MacCarthy A, MacCarthy D, Lawrence VA. Epidemiology of Three Common Surgeries in Veterans with Schizophrenia. Poster session presented at: International Congress on Schizophrenia Research; 2011 Apr 3; Colorado Springs, CO.
Background: Patients in the Veterans Health Administration (VA), the largest integrated healthcare system in the United States, become eligible for VA care as veterans of US military service with service-connected disability, low income or service factors. Veterans with schizophrenia may get care for both mental and physical illnesses. Yet the meager evidence base on surgical experiences of patients with schizophrenia suggests systematic differences compared to patients without severe mental illness (SMI), in that surgical care for persons with schizophrenia may be less timely. The Surgical Treatment Outcomes of Psychiatric Patients (STOPP) study examined 3 of the most common surgeries performed in the VA: coronary-artery bypass graft (CABG), endarterectomy (ENDA), and arthroscopic knee surgery (ARTS) for the period 2006-2009, contrasting veterans with and without schizophrenia or other SMI.
Methods: Administrative data extracts from the VA's all-electronic medical record were aggregated to examine SMI diagnosis and 90-day mortality associated with these 3 surgeries. Diagnosis on 2 or more dates in 1 year identified schizophrenia, other SMI (bipolar disorder, major depressive disorder, post-traumatic stress disorder) and no SMI. CPT and ICD-9-A procedure codes identified invasive surgeries.
Results: Over the 4-year period, the VA treated 7.5 million patients, including 380,000 with 829,000 invasive procedures. The cohort of surgery patients was 4% female, 18% black, 78% white, 3% other race, and 6% of patients were Hispanic. 40% of patients were VA-eligible via low income. Comorbidity status was assessed as 2.6 (SD 2.5) conditions per Charlson score, 4.3 (SD 2.3) chronic conditions per Selim score. CABG was performed on 27,753 patients, ENDA on 14,069, and ARTS on 8,436. Roughly 90,000 schizophrenia patients underwent 2,000 invasive surgeries each year. Patients with schizophrenia were less likely to experience any surgery (2.2% vs 4.1% for non-SMI patients) or to receive the common surgeries (e.g. in 2006, CABG: 4% of schizophrenia vs 6% other SMI vs 7% non-SMI patients; ENDA: 3% schizophrenia vs 5% other SMI vs 6% non-SMI).
Conclusion: In spite of two decades of attention to excess cardiovascular mortality among VA patients with schizophrenia, common surgical treatments, the coronary artery bypass graft and endarterectomy, appear to be performed relatively less often on these vulnerable patients.