Surgical shadows: Evaluating perioperative risks in long-term antipsychotic users

Abstract

Background: The use of antipsychotic medications has risen significantly due to the increasing burden of psychiatric disorders. While these drugs are effective in managing psychosis, their physiological side effects—ranging from cardiovascular instability to altered pain thresholds—pose unique challenges in the perioperative setting. Current literature provides limited data on surgical outcomes in chronic antipsychotic users, necessitating focused investigation. Materials and Methods: This prospective observational study was conducted at the Department of Surgery, Kasturba Medical College, Mangalore, Karnataka, from April 2018 to March 2019. One hundred adult patients (aged 18-65 years) on long-term (>6 months) antipsychotic therapy and scheduled for elective surgeries under general or regional anaesthesia were enrolled. A control group of 100 matched patients not on psychotropic medications was also evaluated. Parameters assessed included intraoperative hemodynamic instability, postoperative delirium, wound healing complications, and length of hospital stay. Data were analyzed using Chi-square, Student’s t-test, and multivariate logistic regression. Results: Patients on antipsychotics showed significantly higher incidence of intraoperative hypotension (34% vs. 14%, p=0.002), postoperative delirium (27% vs. 9%, p=0.001), and delayed wound healing (19% vs. 6%, p=0.008) compared to controls. Mean hospital stay was prolonged (6.2±1.3 vs. 4.5±0.9 days, p