JAMA Logo It is estimated that psychiatric illnesses occur in 5 to 40 percent of hospitalized patients. A recent study suggests that people with co-occurring psychiatric illnesses, particularly anxiety and depression, have heightened chances of death within 30 days of surgery. Apparently, a psychiatric condition is independently correlated with an increased risk of illness and death.

The study included 35,539 surgical patients admitted to intensive care units from October. 1, 2003 to September 30, 2006. Psychiatric condition was probably found in 8,922 patients forming 25.1 percent. While depression was reported by 5,500 representing 15.5 percent, post-traumatic stress disorder was noted in 2,913 presenting 8.2 percent. Anxiety was registered in 2,473 comprising 7 percent, bipolar disorder by 793 representing 2.2 percent and psychosis among 621 presenting 1.8 percent. It was mentioned that before adjustment, 3.8 percent patients with psychiatric illnesses and 4 percent without any conditions had 30-day death rates.

Scientists shared, “Several potential mechanisms exist to explain these findings. First, studies indicate that patients with depression frequently do not adhere to medical recommendations for underlying medical conditions. It is therefore plausible that such undertreated conditions may affect postoperative care and outcomes. Second, patients with existing psychiatric comorbidity may be more likely to undergo surgery by a lower-quality surgeon or hospital. Third, pre-existing psychiatric comorbidity may serve as an indicator for greater severity of surgical risk. The results suggest greater care should be taken among patients with a psychiatric illness who are undergoing surgery. Until further research is completed, we recommend that surgeons caring for patients with a history of anxiety or depression seek early involvement of multidisciplinary teams to help identify problematic areas in perioperative care processes, particularly regarding issues of surgeon-patient communication and adherence to post-surgical recommendations.”

On taking into consideration other factors, Thad E. Abrams, M.D., M.S., of the Iowa City Veterans Affairs Medical Center and University of Iowa Carver College of Medicine, Iowa City, and colleagues observed that 30-day death rates were higher among patients with psychiatric conditions. The risk of dying within 30 days was seemingly correlated with depression and anxiety, but not with any other psychiatric condition. 30-day death rates among those with psychiatric conditions were probably greater for those undergoing respiratory or digestive system procedures. This risk may not be associated with procedures involving the circulatory, nervous or musculoskeletal system.

The study is published in the October issue of Archives of Surgery, one of the JAMA/Archives journals.