Association of mental health assessment with postoperative outcomes following major surgery in older individuals

Introduction: Individuals with mental illness are at risk for poor surgical outcomes. Notably, the impact of preoperative assessment and optimization for high-risk surgical procedures remains a relatively understudied and evolving field. We sought to investigate the association between mental health assessment and postoperative outcomes.

Methods: Older patients with an active mental illness who underwent major surgery between 2016 and 2021 were identified using the Medicare database. Mental health assessment was defined as any encounter with a mental health professional or a claim involving a mental health Current Procedural Terminology code. Major surgery included coronary artery bypass grafting, abdominal aortic aneurysm repair, pneumonectomy, pancreatectomy, and colectomy. Multivariable regression was utilized to examine the association between mental health assessment and textbook outcome.

Results: A total of 32,543 Medicare beneficiaries underwent a major surgical procedure. The most common mental illness was anxiety (n = 11,836; 36.4%), followed by depression (n = 11,258; 34.6%) and psychosis (n = 1,924; 5.9%). Notably, 1,494 individuals (4.6%) had at least 1 mental health assessment within the 6 months preceding the index surgery. Patients who had mental health assessment were more likely to achieve a textbook outcome (no mental health assessment: 38.1% vs mental health assessment: 44.6%; P < .001). In particular, patients who had mental health assessment were less likely to experience complications (no mental health assessment: 38.7% vs mental health assessment: 31.8%), have an extended length of stay (no mental health assessment: 28.5% vs mental health assessment: 22.7%), 90-day mortality (no mental health assessment: 8.1% vs mental health assessment: 6.4%), and 90-day readmission (no mental health assessment: 33.6% vs mental health assessment: 25.8%) (all P < .001). On multivariable analysis, mental health assessment remained independently associated with higher odds of achieving a textbook outcome (odds ratio 1.25, 95% confidence interval 1.12-1.39; P < .001).

Conclusion: Among older individuals with a mental illness who underwent a major surgical procedure, mental health assessment was associated with 25% increased odds of a postoperative textbook outcome. Preoperative care coordination among mental health professionals and surgical care teams is critical to achieve optimal patient outcomes.