Frequency and predictors of perioperative psychiatric symptom worsening among patients with psychiatric disorders

Abstract

Objective: This study aimed to clarify the frequency of perioperative psychiatric symptom worsening among patients with psychiatric disorders and investigate factors predictive of symptom aggravation. Method: This study adopted a retrospective cohort study design. The sample consisted of perioperative inpatients who were diagnosed with psychiatric disorders on admission and received psychiatric intervention between January 1, 2015 and November 31, 2017. Results: Of 176 inpatients who met our inclusion criteria, 15 (8.5%) exhibited symptom worsening. Factors associated with symptom worsening included changes in surface morphology during surgery (p < 0.01; odds ratio (OR) = 10.58; 95% confidence interval (CI), 3.40–32.87), otolaryngological surgery (p = 0.01; OR = 6.95; 95% CI, 1.81–26.75), stay in the intensive care unit (p < 0.01; OR = 5.65; 95% CI, 1.79–17.81), and surgery duration longer than 180 min (p = 0.03; OR = 3.40; 95% CI, 1.04–11.13). Conclusion: This was the first retrospective analysis to focus on the perioperative worsening of psychiatric symptoms. As only few inpatients exhibited symptom aggravation, general hospitals without psychiatric beds can receive perioperative patients with psychiatric comorbidity. However, caution should be exercised to address the potential worsening of symptoms in cases of surface-morphology changing surgery, otolaryngological surgery, long-duration operations, and when ICU stay is required. Keywords: Perioperative management, Psychiatric comorbidity, Patient safety, Medical expense, Medical resource