J Thorac Dis. 2026 May 31;18(5):483. doi: 10.21037/jtd-2025-aw-2208. Epub 2026 May 27.
ABSTRACT
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.
PMID:42306761 | PMC:PMC13266766 | DOI:10.21037/jtd-2025-aw-2208