title: Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration.
abstract: 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.
authors.affiliation: 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.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.affiliation: 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.
authors.forename: John E
authors.initials: JE
authors.lastname: Zeber
authors.affiliation: UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Sako
authors.affiliation: Veterans Affairs: North Texas Veterans Health Care System, 4500 S. Lancaster Rd, Dallas, TX, 75216, USA.|UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Mortensen
authors.affiliation: 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.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: 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.
authors.forename: Chen-Pin
authors.initials: CP
authors.lastname: Wang
authors.affiliation: 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.
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.affiliation: Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA.
authors.forename: Julianne
authors.initials: J
authors.lastname: Flynn
authors.affiliation: Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: MacCarthy
authors.affiliation: UT Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Lawrence
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D055815:Young Adult