title: Mortality after cardiac or vascular operations by preexisting serious mental illness status in the Veterans Health Administration.
abstract: OBJECTIVE
  To estimate 1-year mortality risk associated with preoperative serious mental illness (SMI) as defined by the Veterans Health Administration (schizophrenia, bipolar disorder, posttraumatic stress disorder [PTSD], major depression) following nonambulatory cardiac or vascular surgical procedures compared to patients without SMI. Cardiac/vascular operations were selected because patients with SMI are known to be at elevated risk of cardiovascular disease.
  
  
  METHODS
  Retrospective analysis of system-wide data from electronic medical records of patients undergoing nonambulatory surgery (inpatient or day-of-surgery admission) October 2005-September 2009 with 1-year follow-up (N=55,864; 99% male; <30 days of postoperative hospitalization). Death was hypothesized to be more common among patients with preoperative SMI.
  
  
  RESULTS
  One in nine patients had SMI, mostly PTSD (6%). One-year mortality varied by procedure type and SMI status. Patients had vascular operations (64%; 23% died), coronary artery bypass graft (26%; 10% died) or other cardiac operations (11%; 15%-18% died). Fourteen percent of patients with PTSD died, 20% without SMI and 24% with schizophrenia, with other groups intermediate. In multivariable stratified models, SMI was associated with increased mortality only for patients with bipolar disorder following cardiac operations. Bipolar disorder and PTSD were negatively associated with death following vascular operations.
  
  
  CONCLUSIONS
  SMI is not consistently associated with postoperative mortality in covariate-adjusted analyses.
authors: Center for Applied Health Research, Central Texas Veterans Health Care System, with Baylor Scott & White Health, Temple, TX, USA; Department of Medicine, Texas A&M Health Science Center, and School of Rural Public Health, Bryan/College Station, TX, USA. Electronic address: LaurelACopeland@gmail.com.
authors: Laurel A
authors: LA
authors: Copeland
authors: South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health Science Center at San Antonio, San Antonio, TX, USA.
authors: Edward Y
authors: EY
authors: Sako
authors: Center for Applied Health Research, Central Texas Veterans Health Care System, with Baylor Scott & White Health, Temple, TX, USA; Department of Medicine, Texas A&M Health Science Center, and School of Rural Public Health, Bryan/College Station, TX, USA.
authors: John E
authors: JE
authors: Zeber
authors: South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health Science Center at San Antonio, San Antonio, TX, USA.
authors: Mary Jo
authors: MJ
authors: Pugh
authors: South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health Science Center at San Antonio, San Antonio, TX, USA.
authors: Chen-Pin
authors: CP
authors: Wang
authors: South Texas Veterans Health Care System, San Antonio, TX, USA.
authors: Andrea A
authors: AA
authors: MacCarthy
authors: South Texas Veterans Health Care System, San Antonio, TX, USA; UT Health Science Center at San Antonio, San Antonio, TX, USA.
authors: Marcos I
authors: MI
authors: Restrepo
authors: VA North Texas Health Care System, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors: Eric M
authors: EM
authors: Mortensen
authors: UT Health Science Center at San Antonio, San Antonio, TX, USA.
authors: Valerie A
authors: VA
authors: Lawrence
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D058014:Veterans Health / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cardiovascular surgical procedures; Comorbidity; Mental disorders; Mortality; Veterans