Influence of psychiatric comorbidity on surgical mortality.
OBJECTIVE
To examine the potential effect of 5 existing psychiatric comorbidities on postsurgical mortality.


METHODS
Retrospective cohort.


METHODS
Intensive care units of all Veterans Health Administration hospitals designated as providing acute care.


METHODS
We studied 35 539 surgical patients admitted to intensive care units from October 1, 2003, through September 30, 2006.


METHODS
Psychiatric comorbidity (depression, anxiety, posttraumatic stress disorder, bipolar disease, and schizophrenia) was identified using outpatient encounters in the 12 months preceding the index admission. End points included in-hospital and 30-day mortality. Generalized estimating equations accounted for hospital clustering and adjusted mortality for demographics, type of surgery, medical comorbidity, and disease severity.


RESULTS
We identified 8922 patients (25.1%) with an existing psychiatric comorbidity on admission. Unadjusted 30-day mortality rates were similar among patients with and without psychiatric comorbidity (3.8% vs 4.0%, P = .56). After adjustment, 30-day mortality was higher for patients with psychiatric comorbidity (odds ratio, 1.21; 95% confidence interval, 1.07-1.37; P = .003). In individual analyses, patients with depression and anxiety had higher odds of 30-day mortality (P = .01 and P = .02, respectively) but the odds were similar for the other conditions.


CONCLUSIONS
Existing psychiatric comorbidity was associated with a modest increased risk of death among postsurgical patients. Estimates of the increased risk across the individual conditions were highest for anxiety and depression. The higher mortality may reflect higher unmeasured severity or unique management issues in patients with psychiatric comorbidity.
Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, IA 52246-2208, USA. thad-abrams@uiowa.edu
Thad E
TE
Abrams
Mary
M
Vaughan-Sarrazin
Gary E
GE
Rosenthal
D000368:Aged; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011618:Psychotic Disorders / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology