Diagnosis of Mental Illness Does Not Affect Post-Operative Outcomes in Patients Undergoing Endovascular Aortic Aneurysm Repair in the VA Health Care System
Diana Otoya1, Sonia Lele2, Douglas Hogan1, Sally Boyd1, Kedar Lavingia1, Michael F Amendola1
1VA Medical Center/VCU, Richmond, VA;2Sonia Lele, Richmond, VA
BACKGROUND:
Mental health illness can be a highly debilitating chronic disease state which can result in increased surgical comorbidities and mortality. High prevalence of mental illness among the veteran population has been reported with increased rates of depression, anxiety, post-traumatic stress disorder (PTSD), substance abuse, and/or major mental health disorders (schizophrenia and bipolar disorder). Literature suggests that mental illness can greatly contribute to increased post-operative mortality, complications, and length of stay. Given the prevalence of mental health disorders within the veteran population, we set forth to examine post-surgical outcomes in patients undergoing endovascular aortic aneurysm repair (EVAR).
METHODS:
After Institutional Board Review approval, we retrospectively queried our Veterans Administration Hospital operative database to identify patients who underwent EVAR from January 2010 to December 2021. Patients’ factors collected included: age, past medical history, smoking status, medications, mental illness diagnosis, anesthesia type, operative time, estimated blood loss, access type, operative complications, and mortality. Chi squared* , students t-test ** and ANOVA† were used to assess the differences between the groups. Binary logistic regression was used to assess whether mental illness status was associated with post operative complications, readmission rates, length of stay and 30-day operative mortality.
RESULTS:
A total of 241 patients underwent EVAR procedures. 140 male patients were diagnosed with mental health illness with a mean age of 70 years. 65.7% had history of substance abuse disorder, 38.6% depression, 29.3% PTSD, 19.3% anxiety, 3.6% major psychiatric illness. There was no statistical difference in medical comorbidities, race, smoking status, medications when compared to general population. We found no differences in post-operative outcomes between patients with and without a diagnosis of mental illness (TABLE 1). Logistic regression demonstrates no statistically significant increase in overall post operative complications, readmission rates, length of stay and 30-day operative mortality regardless of an overall diagnosis of mental illness, anxiety, depression or substance abuse (TABLE 2). Only 8.6% of patients with mental health diagnosis were lost to follow up compared to 16.2% of the general population (p=0.07*).
CONCLUSIONS:
Contrary to previous research, we found no association between mental health diagnosis and worse post EVAR surgical outcomes in a veteran population. Diagnosis of mental health disorder did not correlate with increased complications, readmission, greater length of stay nor increased 30-day mortality. Interestingly, there was a trend to a lower loss to follow-up rate in patients with mental illness diagnosis. This finding possibly indicates an identifying, monitoring, treating, and supporting this high-risk population in the VHA system. Further research is needed to assess the association between post-surgical outcomes and mental illness diagnosis in patients undergoing EVAR. 
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