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Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta‐analysis
Author(s) -
McBride Kate E,
Solomon Michael J,
Ban Paul G,
Glozier Nicholas,
Steffens Daniel
Publication year - 2021
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.51009
Subject(s) - medicine , meta analysis , odds ratio , mental illness , cochrane library , confidence interval , medline , publication bias , mental health , psychiatry , political science , law
Objective To assess the association between having a serious mental illness and surgical outcomes for adults, including in‐hospital and 30‐day mortality, post‐operative complications, and hospital length of stay. Study design Systematic review and meta‐analysis of publications in English to 30 July 2018 of studies that examined associations between having a serious mental illness and surgical outcomes for adults who underwent elective surgery. Primary outcomes were in‐hospital and 30‐day mortality, post‐operative complications, and length of hospital stay. Risk of bias was assessed with the Quality in Prognosis Studies (QUIPS) tool. Studies were grouped by serious mental illness diagnosis and outcome measures. Odds ratios (ORs) or mean differences (MDs), with 95% confidence intervals (CIs), were calculated in random effects models to provide pooled effect estimates. Data sources MEDLINE, EMBASE, PsychINFO, and the Cochrane Library. Data synthesis Of the 3824 publications identified by our search, 26 (including 6 129 806 unique patients) were included in our analysis. The associations between having any serious mental illness diagnosis and having any post‐operative complication (ten studies, 125 624 patients; pooled effect: OR, 1.44; 95% CI, 1.15–1.79) and a longer stay in hospital (ten studies, 5 385 970 patients; MD, 2.6 days; 95% CI, 0.8–4.4 days) were statistically significant, but not those for in‐hospital mortality (three studies, 42 926 patients; OR, 1.21; 95% CI, 0.69–2.12) or 30‐day mortality (six studies, 83 013 patients; OR, 1.85; 95% CI, 0.86–3.99). Conclusions Having a serious mental illness is associated with higher rates of post‐operative complications and longer stays in hospital, but not with higher in‐hospital or 30‐day mortality. Targeted pre‐operative interventions may improve surgical outcomes for these vulnerable patients. Systematic review registration PROSPERO, CRD42018080114 (prospective).