PTSD increases risk of death one year after surgery

A study conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco offers evidence that veterans with post-traumatic stress disorder have a significantly lower survival rate one year after surgery than veterans without the diagnosis, even though the veterans with PTSD were seven years younger on average.

In the study of 1,792 male veterans who underwent an elective major surgery requiring hospital admission, PTSD emerged as a significant risk factor for one-year post-operative mortality, even after the authors adjusted for age and for pre-existing medical conditions that are known to increase the chances of death after surgery.

The results of the study were presented by lead author Marek Brzezinski, MD, PhD, a staff physician at SFVAMC, at the 2009 annual meeting of the American Society of Anesthesiologists in New Orleans. “This is the first time that PTSD, a psychiatric diagnosis, has been shown as a risk factor for increased mortality after surgery,” said Brzezinski, who is also an assistant professor of anesthesia and perioperative care at UCSF.

In analyzing the data, which was gleaned from the electronic patient-record database at SFVAMC, the researchers also found that a PTSD diagnosis was associated with significantly higher prevalence of risk factors for cardiovascular disease, including high blood pressure, high cholesterol, smoking, and alcohol abuse – all of which are known to increase the risk of death after surgery. It also was associated with other known risk factors for post-operative mortality, including diabetes, depression, and drug abuse.

“Nonetheless, even after controlling for these comorbidities, PTSD emerged as a significant independent risk factor,” noted Brzezinski. “The effect of PTSD on post-operative mortality was at least as large as, if not larger than, diabetes, a well-known risk factor, which was surprising.”

He emphasized that the study was not designed to investigate the reasons for the increased risk. “There is something that PTSD does to our bodies, perhaps associated with continuously elevated stress levels,” he speculated.

Brzezinski urged anesthesiologists and other physicians to be aware of PTSD as a new surgical risk factor: “In addition to asking patients if they have diabetes or heart disease, we should start asking them if they have ever been diagnosed with PTSD.”

Brzezinski says that important as these findings are for veterans, “They are potentially even more significant for the VA health system as a whole. Our study suggests that chronic medical conditions developed years after active duty could be related to the long-term effects of PTSD.”

In an effort to expand their understanding of the relationship of PTSD and postsurgical mortality, Brzezinski and his colleagues are in the process of conducting a prospective epidemiological study looking at the effects of PTSD on surgical outcomes.

Co-authors of the study are Charles Marmar, MD, and Brian Cason, MD, of SFVAMC and UCSF; Selwyn Au, MS, of UCSF; and senior author Arthur Wallace, MD, PhD, a staff physician at SFVAMC and a professor of anesthesiology and perioperative medicine at UCSF. Brzezinski, Cason, Marmar, and Wallace are currently preparing a study that will examine the potential protective effects of medical therapy in patients with PTSD who are undergoing surgery.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.