Outcomes of comorbid mental health disorders in cardiovascular surgery.

BACKGROUND

Mental illness is recognized by the Centers for Disease Control and Prevention as a global public health problem. Traditional cardiac surgical risk stratification tools typically do not include any assessment for mental illness. This study sought to examine the impact of pre-existing mental health disorders (MHDs) (including psychotic, mood, anxiety, behavioral, and personality disorders) on in-hospital cardiovascular surgery outcomes.

METHODS

This study used the 2016-2018 Nationwide Readmissions Database (NRD). It identified patients undergoing cardiovascular surgery and flagged those with and without MHDs using the relevant procedure and diagnosis codes. A propensity score matching (PSM) approach was used to balance covariates between patients with and without MHDs to evaluate the association between MHDs and each of the complications, in-hospital mortality, 30- and 90-day readmissions. Subsequently, multivariable logistic regression was conducted to evaluate the independent association between MHDs and the study outcomes, after adjusting for covariates.

RESULTS

Of the 844,830 discharges who underwent cardiovascular surgery, 165,597 (20%) had MHDs. Among propensity score-matched pairs, in-hospital mortality was lower in patients with MHDs (2.3% vs. 3.2%, P<0.001), possibly because those undergoing surgery are among the healthier and/or least disadvantaged individuals among those with MHDs. However, they had a longer mean length of stay (LOS; 12 vs. 11 days, P<0.001). MHDs were also associated with higher odds of complications [adjusted odds ratio (aOR): 1.16, 95% confidence interval (CI): 1.14-1.19], and higher odds of 30- and 90-day readmission (aOR: 1.17, 95% CI: 1.14-1.21; and aOR: 1.18, 95% CI: 1.14-1.21, respectively).

CONCLUSIONS

Surgeons may consider optimizing psychiatric status and involving mental health professionals to improve outcomes in this vulnerable population.