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Perforated appendicitis in patients with schizophrenia: a retrospective cohort study
Yoshimasa Nishihira1, Rita L McGill2, Mitsuyo Kinjo3
1Department of Psychiatry, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.
Objective:
Altered pain sensitivity may affect the outcome of appendicitis in patients with schizophrenia. We aimed to compare the prevalence of perforation in appendicitis between patients with and without schizophrenia.
Design:
Retrospective cohort study with random matching.
Setting:
A single tertiary medical centre in Japan.
Participants:
From 1985 to 2013, 1821 cases of appendicitis requiring appendectomy were collected. Patients with schizophrenia and a cohort of randomly selected control subjects without schizophrenia who underwent appendectomy were identified.
Primary And Secondary Outcome Measures:
The primary outcome was the rate of perforated appendicitis in patients with and without schizophrenia. Secondary outcome was the odds of perforated appendicitis by different clinical factors.
Results:
62 patients with schizophrenia and randomly sampled 200 non-schizophrenic patients were compared. The prevalence of perforation was 53% in patients with schizophrenia versus 17% in controls (p<0.0001). The adjusted OR for perforation were 4.87 (95% CI: 2.33 to 10.2) for schizophrenia, 3.35 (95% CI 1.51 to 7.45) for age >55 years and 2.18 (95% CI: 1.12 to 4.27) for delayed presentation.
Conclusion:
Appendiceal perforation was more frequent in patients with schizophrenia than controls, which may be partly attributable to delayed presentation and altered responses to pain.
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