Specialty: Ophthalmology

Keywords: mental health, ophthalmology, psychiatric illness, surgery cancellation, veterans

Background: Nearly nine million veterans receive healthcare at the Veterans Health Administration (VA), many of whom have psychiatric illnesses. The military continues to have higher rates of psychiatric illness compared to the civilian population. Having a diagnosis such post-traumatic stress disorder (PTSD) or depression may create challenges in utilizing healthcare services, such as surgery.

Objective: The purpose of this study was to evaluate eye surgery cancellation, risk factors for cancellation, and areas for intervention within the VA. 

Methods: This was a single-center retrospective cohort study. The Veteran Health Information Systems and Technology Architecture was queried to identify all surgical requests at the West Los Angeles VA in 2019. Data collection included sociodemographic information and co-morbid medical conditions, including psychiatric illness. Exploratory analyses using univariate logistic regression were used to evaluate factors associated with surgery cancellation.

Results: A total of 1,115 surgical requests were identified with a cancellation rate of 23.7% (n=270). Sociodemographic factors were similar between those with completed and cancelled surgery. However, having a psychiatric diagnosis correlated with surgery cancellation. For all subspecialties, patients with schizophrenia were more likely to have cancellation (OR 2.53, p=.04). For retina surgery, patients with PTSD were more likely to have cancellation (OR 4.23, p=.01). Glaucoma patients with anxiety (OR 5.78, p=.05) and depression (OR 4.05, p=.04) were more likely to have cancellation. 

Conclusions: There was a significant amount of eye surgery cancellations in veterans with variation by subspecialty and co-morbid conditions. Having a psychiatric illness was correlated with increased rates of surgery cancellation amongst veterans. Areas to improve surgical utilization include risk stratification and increased support of vulnerable patients prior to surgery.