A retrospective cohort study involving elective overnight surgical patients aged 18 years and above who attended a large public tertiary referral hospital in Sydney, Australia, between 2010 and 2014 analysed the impact that severe mental illness (SMI) had on outcomes. 
Of 23 343 surgical patient admissions, 451 (2%) patients had decompensated comorbid SMI with a subset of 47 (0.2%) having a psychotic illness. Patients with SMI had significantly higher in-hospital mortality (2% versus 0%), postoperative complications (22% versus 8%), total comorbidity (7.6 versus 3.4 secondary codes), admissions (29% versus 9%) and time in intensive care (34.6 h versus 5.0 h), stay in hospital (12.2 days versus 4.6 days), admission costs ($24 162 versus $12 336, a 95.9% increase), re-admission within 28 days (14% versus 10%) and discharges to another facility (11% versus 3%).
The authors suggest that specific perioperative interventions are needed to proactively improve the identification, management and outcomes of these patients.
1 McBride KE, Solomon MJ, Young JM, et al. Impact of serious mental illness on surgical patient outcomes. ANZ J Surg 2018;88:673–7. doi:10.1111/ans.14508