Appendectomy for appendicitis in patients with schizophrenia

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.