Thoracic Surgery in Mentally Ill Patients

Analysis of the 388 procedures performed on 343 tuberculous and non-tuberculous mentally ill patients reveals a post-operative mortality of 23 (6.7 per cent). The overall percentage of post-operative mortality for tuberculous patients was 5.6 per cent. The latter mortality, however, occurred only after excisional surgery and represents a rate of 7.9 per cent for resections, which compares favorably with those performed on non-mental patients. The operative mortality in the non-tuberculous patients was greater, due to early death from progression of the malignant process. One hundred and fifty-seven (45.8 per cent) of these patients were over the age of 50 years and 15 (65.2 per cent) of the post-operative mortality were in this age group. Atelectasis occurred after 73 (18.8 per cent) of the procedures. Post-operatively patients must be closely observed and active measures initiated before massive atelectasis occurs. This is especially true of the severe mental deficients and the chronic psychotic patients who are passively cooperative prior to surgery and refuse or are unable to follow instructions in the post-operative phase, occasionally becoming catatonic. Among the patients with pulmonary tuberculosis, good results were obtained in 82 per cent. Eight patients are still on chemotherapy and are negative.