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

Laurel A. Copeland, John E. Zeber, Edward Y Sako, Eric M. Mortensen, Mary Jo Pugh, Chen-pin Wang, Marcos Restrepo, Julianne Flynn, Andrea A. MacCarthy, Valerie A. Lawrence

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Article number74
JournalBMC Surgery
Volume15
Issue number1
DOIs
StatePublished - Jun 18 2015

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Veterans Health
United States Department of Veterans Affairs
Veterans
Demography
Social Adjustment
Major Depressive Disorder
Vulnerable Populations
Poverty
Post-Traumatic Stress Disorders
Bipolar Disorder
African Americans
Psychotic Disorders
Medical Records
Psychiatry
Comorbidity
Inpatients
Schizophrenia
Retrospective Studies
Odds Ratio

Keywords

  • Bipolar disorder
  • Depressive disorder
  • Operative
  • Post-traumatic stress disorder
  • Schizophrenia
  • Surgical procedures
  • Veterans

ASJC Scopus subject areas

  • Surgery

Cite this

Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration. / Copeland, Laurel A.; Zeber, John E.; Sako, Edward Y; Mortensen, Eric M.; Pugh, Mary Jo; Wang, Chen-pin; Restrepo, Marcos; Flynn, Julianne; MacCarthy, Andrea A.; Lawrence, Valerie A.

In: BMC Surgery, Vol. 15, No. 1, 74, 18.06.2015.

Research output: Contribution to journalArticle

Copeland, Laurel A. ; Zeber, John E. ; Sako, Edward Y ; Mortensen, Eric M. ; Pugh, Mary Jo ; Wang, Chen-pin ; Restrepo, Marcos ; Flynn, Julianne ; MacCarthy, Andrea A. ; Lawrence, Valerie A. / Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration. In: BMC Surgery. 2015 ; Vol. 15, No. 1.
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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.",
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AU - Copeland, Laurel A.

AU - Zeber, John E.

AU - Sako, Edward Y

AU - Mortensen, Eric M.

AU - Pugh, Mary Jo

AU - Wang, Chen-pin

AU - Restrepo, Marcos

AU - Flynn, Julianne

AU - MacCarthy, Andrea A.

AU - Lawrence, Valerie A.

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N2 - 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.

AB - 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.

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