心血管手术中合并心理健康障碍的结果
Outcomes of comorbid mental health disorders in cardiovascular surgery.
摘要(中文译文)
精神疾病被美国疾病控制与预防中心认定为全球性公共卫生问题。传统的心脏外科风险分层工具通常不包含任何精神疾病的评估。本研究旨在探讨既往存在的精神健康障碍（MHDs）（包括精神病性障碍、心境障碍、焦虑障碍、行为障碍和人格障碍）对住院心血管手术结局的影响。本研究使用了2016至2018年全国再入院数据库（NRD），识别接受心血管手术的患者，并通过相关手术和诊断代码标记伴有和不伴有MHDs的患者。采用倾向性评分匹配（PSM）方法平衡伴有和不伴有MHDs患者之间的协变量，以评估MHDs与各并发症、住院死亡率、30天和90天再入院之间的关联。随后，在调整协变量后，进行多因素logistic回归分析以评估MHDs与研究结局之间的独立关联。在844,830例接受心血管手术的出院患者中，165,597例（20%）患有MHDs。在倾向性评分匹配对中，伴有MHDs的患者住院死亡率较低（2.3% vs 3.2%，P<0.001），这可能是因为接受手术的患者属于MHDs人群中较健康者和/或处境较优者。然而，他们的平均住院时间（LOS）较长（12天 vs 11天，P<0.001）。MHDs还与更高的并发症发生风险相关[调整比值比（aOR）：1.16，95%置信区间（CI）：1.14-1.19]，以及更高的30天和90天再入院风险（aOR：1.17，95% CI：1.14-1.21；aOR：1.18，95% CI：1.14-1.21）。外科医生可考虑优化精神状况并引入精神卫生专业人员，以改善这一脆弱人群的结局。
Abstract
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. 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. 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% . 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 . 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). Surgeons may consider optimizing psychiatric status and involving mental health professionals to improve outcomes in this vulnerable population.
如何引用
AMA
Grace M Soltesz, Jose L Diz Ferre, Guangjin Zhou, Siran M Koroukian, Krish C Dewan. Outcomes of comorbid mental health disorders in cardiovascular surgery.. Journal of thoracic disease. 2026; doi:10.21037/jtd-2025-aw-2208.
APA
Grace M Soltesz, Jose L Diz Ferre, Guangjin Zhou, Siran M Koroukian, Krish C Dewan (2026). Outcomes of comorbid mental health disorders in cardiovascular surgery.. Journal of thoracic disease. https://doi.org/10.21037/jtd-2025-aw-2208
GB/T 7714
Grace M Soltesz, Jose L Diz Ferre, Guangjin Zhou, Siran M Koroukian, Krish C Dewan. Outcomes of comorbid mental health disorders in cardiovascular surgery.[J]. Journal of thoracic disease, 2026 doi:10.21037/jtd-2025-aw-2208.
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