Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration.

Autor: Copeland LA; Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. LaurelACopeland@gmail.com.; Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. LaurelACopeland@gmail.com.; Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA. LaurelACopeland@gmail.com.; UT Health Science Center San Antonio, San Antonio, TX, USA. LaurelACopeland@gmail.com., Zeber JE; Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.; Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.; Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA.; UT Health Science Center San Antonio, San Antonio, TX, USA., Sako EY; UT Health Science Center San Antonio, San Antonio, TX, USA., Mortensen EM; Veterans Affairs: North Texas Veterans Health Care System, 4500 S. Lancaster Rd, Dallas, TX, 75216, USA.; UT Southwestern Medical Center, Dallas, TX, USA., Pugh MJ; UT Health Science Center San Antonio, San Antonio, TX, USA.; Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA., Wang CP; UT Health Science Center San Antonio, San Antonio, TX, USA.; Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA., Restrepo MI; UT Health Science Center San Antonio, San Antonio, TX, USA.; Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA., Flynn J; Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA., MacCarthy AA; Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA., Lawrence VA; UT Health Science Center San Antonio, San Antonio, TX, USA.
Jazyk: angličtina
Zdroj: BMC surgery [BMC Surg] 2015 Jun 18; Vol. 15, pp. 74. Date of Electronic Publication: 2015 Jun 18.
DOI: 10.1186/s12893-015-0064-7
Abstrakt: 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.
Databáze: MEDLINE
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