NATIONWIDE SERIOUS MENTAL ILLNESS (SMI) NEGATIVELY IMPACTS ACUTE SURGICAL
OUTCOMES
KB Williams MD; JF Bradley3rd MD; BA Wormer MD; AL Walters MS; JM Green MD;
VA Augenstein MD; RF Sing DO; BT Heniford MD—Carolinas Medical Center, NC
Introduction: The impact of SMI on surgical outcomes is poorly studied. We examined the effect of
SMI nationally on acute surgical illness.
Methods: The National Impatient Sample, was queried (1998-2010) using ICD-9 codes for acute, nonelective appendectomy(Appy), cholecystectomy(Choley) or left-sided colectomy(Colon).
Schizophrenia(SZ) and drug-related SMI(DRMI) were compared to non-SMI(NON). Demographics,
comorbidities, time to operation, complications, payor status, total hospital charges, LOS were examined.
Standard statistical and multivariate regression(MVR) analyses were applied. Significance was p<0.05.
Results: A total of 1,100,423 patients were identified(63.6%-Appy,30.2%-Choley,6.3%-Colon). Patients
with SMI included: 0.3%-SZ and 1.7%-DRMI. Demographics were: age-40.6±21.8 years, race-66.9%
Caucasian, Charlson Comorbidity Index(CCI)-0.4±0.9. Insurance was more likely not private for
SMI(80.7%-SZ, 40.5%-DRMI, 31.0%-NON; p<0.0001). Significant differences in complications were
noted (SZ,DRMI,NON): intraoperative(1.7%,2.3%,1.2%), wound(1.5%,1.7%,0.6%), infectious
(2.8%,2.7%,1.3%), pulmonary(5.1%,4.9%,2.3%), gastrointestinal(6.7%,6.2%,4.0%), reoperation
(0.9%,0.9%,0.3%) and mortality(1.2%,1.2%,0.7%). Systemic complications were significant for SZ
versus NON(1.8%,1.0%;p<0.0001); cardiovascular complications were significant for DRMI versus
NON(1.5% vs 0.9%;p<0.0001). MVR controlling for age, gender, region, hospital teaching status,
operation, primary payor, CCI and SMI type demonstrated SZ and DRMI significantly increased odds of
complications(wound, infectious, pulmonary, gastrointestinal, reoperation, mortality); odds of systemic
and intraoperative complications were increased for SZ versus NON and DRMI versus NON,
respectively(Table). SMI significantly (p<0.05) increased LOS(2.07±0.09,1.45±0.04 days), total
charges($8704±655,$8153±266), and time to operation(0.5±0.04,0.4±0.02 days) over NON.
Conclusions: This study demonstrates serious mental illness has a significant negative impact on
operative complications in acute surgical procedures.
Complications for SMI in Acute Surgery
Complication
Wound
Infectious
Pulmonary
GI
Systemic
Operative
Reoperation
Mortality
Schizophrenia
OR (95% CI)*
P-value
2.14 (1.58-2.91)
<0.0001
2.03 (1.62-2.55)
<0.0001
1.87 (1.58-2.22)
<0.0001
1.56 (1.34-1.82)
<0.0001
1.65 (1.24-2.19)
0.0006
1.14 (0.85-1.52)
0.3923
2.56 (1.73-3.78)
<0.0001
1.67 (1.18-2.36)
0.0041
*Odds ratio expressed versus non-SMI
Drug Related-SMI
OR (95% CI)*
P-value
1.97 (1.75-2.22)
<0.0001
1.63 (1.48-1.79)
<0.0001
1.64 (1.53-1.77)
<0.0001
1.30 (1.22-1.38)
<0.0001
1.08 (0.94-1.25)
0.2635
1.45 (1.31-2.30)
<0.0001
1.95 (1.65-2.30)
<0.0001
1.37 (1.19-1.59)
<0.0001