Clinical surgery–American
Appendectomy for appendicitis in patients with schizophrenia

Presented as a poster at the World Congress of Gastroenterology, Montreal, Canada, September 10–14, 2005, and Association for Academic Surgeons meeting, San Diego, CA, February 8–11, 2006
https://doi.org/10.1016/j.amjsurg.2006.06.034Get rights and content

Abstract

Background

Anecdotal evidence suggests that schizophrenia patients who require surgery have a high rate of adverse outcomes. We searched the Department of Veterans Affairs national datasets to determine the clinical course of schizophrenia patients with appendicitis who underwent appendectomy.

Methods

The Patient Treatment File (the nationwide inpatient database for the Department of Veterans Affairs) and the Beneficiary Identification and Records Location System were searched to identify all patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes for schizophrenia or schizoaffective disorder diagnosed with appendicitis during fiscal years 1995 to 1999. Computer-based information was supplemented with chart-based data. We sought data on six common preoperative risk factors and 25 specific adverse outcomes, including death.

Results

There were 55 patients identified. The mean age was 49, and 96% were men. The median time from symptom onset to diagnosis of appendicitis was 3 days. A history of substance abuse was obtained in 16 (29%). Disruptive behavior was documented in 16 (29%). Restraints were used in 9 (9%). The appendix was perforated in 36 (66%) and gangrenous in 9 (16%). Thirty-one (56%) had ≥1 complication; there were 2 in-hospital deaths (4%).

Conclusions

This is the first report on this topic in the medical literature. Appendicitis is typically diagnosed late in schizophrenic patients. Adverse patient behaviors are frequent. The complication and death rates are high.

Section snippets

Methods

Institutional review board approval was obtained for this research. The Patient Treatment File (PTF), which is the nationwide inpatient database for the VA, was the primary data source for this study. This computer-based information was accessed through the VA Data Processing Center in Austin, Texas, which maintains the administrative databases for all VA facilities. We have used this approach extensively for clinical research. Its main components are an IBM mainframe computer (Model 2864-265)

Results

Of the more than 4 million patients who received medical care at VA medical centers during the study period, there were 5,527 who underwent appendectomy at 131 centers with inpatient facilities. Of these, 71 patients at 45 VA medical centers had ICD-9-CM codes for schizophrenia or schizoaffective disorder and underwent appendectomy.

We received data on 68 patients (96% of 71). Applying the exclusion criteria resulted in the exclusion of 13 of these patients. As is common for administrative data

Discussion

The optimal management of appendicitis relies on many factors. The patient should seek medical attention in a timely fashion. How the patient relates his symptoms to his physician and the physician’s skill in eliciting historical information are key factors in diagnosis. Schizophrenic patients differ from other patients in these areas. The physician should also be able to recognize and adapt to this fact. Appropriate laboratory testing, imaging studies, and surgical consultation can aid in

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