Mental Health Disorders Not Linked to Poor Outcomes in Veterans Who Have EVAR

A previous mental health disorder diagnosis is not associated with worse outcomes in veteran patients who receive endovascular aortic aneurysm repair (EVAR), according to a study in the Journal of Vascular Surgery.

The retrospective study reviewed all EVARs performed at a Veterans Administration Hospital between January 2010 and December 2021.

The researchers obtained data regarding patient demographics, anticoagulation or antiplatelet medication use at the time of the EVAR procedure, pre-existing medical comorbidities contributing to vascular disease, and mental health disorder status.

The primary outcomes were follow-up rates, postoperative complications, and mortality. Postoperative complications included infection, acute kidney injury, bleeding, return to the operating room, hemodynamic instability, respiratory failure requiring ventilatory support, urinary tract infection, myocardial infarction, and stroke.

A total of 241 patients (mean age, 71.5±6.9 years; 99.2% men) had infrarenal EVARs during the study period, of whom 58.1% were diagnosed with a mental health disorder and 41.9% had no previous diagnosis of a mental health disorder.

Among the patients who were previously diagnosed with a mental health disorder, 92 (43%) had a history of substance abuse disorder, 54 (25%) had depression, 41 (19%) had post-traumatic stress disorder (PTSD), and 27 (13%) had anxiety. In addition, 5 (3.6%) patients were diagnosed with a major psychiatric disorder, 3 with bipolar disorder, 2 with schizophrenia, and 23.7% had more than 1 mental health disorder diagnosis. More than half of the patients with a mental health disorder were receiving active treatment at the institution.

The mean follow-up was 1931.8 days (5.3 years), and the median follow-up was 1979.0 days (5.4 years). No statistically significant differences in demographics or medical comorbidities were observed in the patients with and without a mental health disorder. The 2 groups also had a similar preoperative albumin level, body mass index, and smoking status, as well as antiplatelet or anticoagulation use. A statistically significant difference was found between anesthesia type used in the 2 groups, with a higher percentage of epidurals used in patients without a mental health disorder diagnosis (9.9%) vs those with a mental health disorder (1.4%; P =.007).

Patients with a mental health disorder had a statistically significantly lower composite postoperative complication rate (28.6% vs 32.7%; P =.05). No statistically significant differences occurred for readmission rate or 30-day mortality. A significantly reduced percentage of patients with a mental health disorder were lost to follow-up compared with those without a mental health disorder (8.6% vs 15.8%; P =.05).

In binary logistic regression analysis, no statistically significant differences were found in the primary outcomes of postoperative complications, readmission rates, loss to follow-up, and 1-year mortality in stratification according to mental health disorder type. Cox proportional hazards modeling yielded a hazard ratio of 0.56 (95% CI, 0.29-0.107) for patients with a mental health disorder, although it was not statistically significant (P =.08).

In the analysis according to mental health disorder subtype, no statistical significance was found in cumulative survival hazard ratios in patients with a diagnosis of PTSD (1.59; 95% CI, 0.88- 2.88; P =.13), anxiety (1.25; 95% CI, 0.65-2.43; P =.50), substance abuse disorder (0.84; 95% CI, 0.49-1.46; P =.55), and depression (0.69; 95% CI, 0.42-1.16; P =.17).

Limitations of the study include the retrospective design being limited to EVARs performed at a single institution. Also, the cohort is primarily men, and the analysis did not stratify between treated and untreated mental health disorder, which could have affected outcomes.

“Veterans Health Administration resources and multidisciplinary support of patients with mental illness diagnoses may improve adherence and follow-up rates, mitigating postoperative complications in patients undergoing EVARs,” wrote the study authors.