The Impact Of Mental Illness On Peri-operative Outcomes Among Medicare Beneficiaries - A Missed Opportunity To Help Surgical Patients?
*Anghela Z. Paredes, *Madison Hyer, *Adrian Diaz, *Diamantis I Tsilimigras, Timothy M Pawlik
The Ohio State University, Columbus, OH
Introduction: Pre-operative surgical evaluation and risk stratification has traditionally centered on optimizing physical health. The influence of mental health on post-operative surgical outcomes has not been investigated.
Methods: Patients who underwent coronary artery bypass grafting, colectomy, total hip arthroplasty, and lung resection between 2012-2017 were identified using Medicare Standard Analytic Files. Multivariable logistic regression was used to assess the impact of pre-operative mental illness on complications, readmission, and mortality.
Results: Overall, 391,392 (30.6%) patients had a pre-operative diagnosis of mental illness (anxiety, 8.6%; depression, 9.4%; anxiety and depression, 9.8%; severe mental illness, 2.8%). Patients who did and did not have mental illness were comparable relative to age, race and comorbidity burden. On multivariable analysis, after adjusting for disease and procedure-specific variation, patients with pre-operative mental illness had a higher chance of surgical complications (OR1.43, 95%CI 1.41-1.45) and were more likely to experience prolonged length-of-stay (OR1.53, 95%CI 1.51-1.55). Patients with a history of mental illness also had higher odds of non-home discharge (OR1.77, 95%CI 1.76-1.79), as well as 30-day readmission (OR1.91, 95%CI 1.89-1.94). In addition, individuals with mental illness had a higher prevalence of suicidal ideation within the first year following surgery (mental illness: 825.7 per 100,000 individuals versus no mental illness: 16.4 per 100,000 individuals; p<0.05).
Discussion: Three in ten Medicare beneficiaries had pre-existing mental illness, which was strongly associated with worse peri-operative outcomes, as well as suicide risk. Surgeons need to optimize mental health assessment and services in the pre-operative setting to improve outcomes for this vulnerable population.
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