National Meeting 2007

3001 — Does Psychiatric Comorbidity Impact Adverse Hospital Outcomes?

Abrams TE (CRIISP) , Sarrazin MS (CRIISP), Rosenthal GE (CRIISP)

Prior research has found that psychiatric conditions can impact longer term outcomes. However, the impact of psychiatric conditions on outcomes of acute hospitalizations is poorly studied. Thus, we examined the prognostic impact of psychiatric comorbidities on hospital mortality. We hypothesized that these veterans would have a higher risk of death.

The VA Patient Treatment File (PTF) was used to identify consecutive veterans admitted to all VA facilities in FY 2004 with a principle diagnosis of congestive heart failure (CHF; n=16,945) or pneumonia (n=19,285). Mortality 30 days after admission was ascertained from the PTF and the Beneficiary Identifier Record Locator System. The presence of psychiatric and medical comorbidities was identified using ICD-9-CM diagnoses from the index hospitalization and all outpatient encounters during the previous 24 months. Psychiatric diagnoses examined included; PTSD, depression, anxiety, and psychosis. We used hierarchical logistic regression models to compare 30 day mortality rates for each cohort adjusting for socio-demographics, medical comorbidity, and accounting for hospital clustering.

Mean ages of the CHF and pneumonia cohorts were 70.2 ±11.5 and 69.8 ± 12.7 respectively. Rates of psychiatric illness were clinically similar in both cohorts; PTSD (5.7% vs. 7.2%), depression (19.4% vs. 22.7%), anxiety (7.3% vs. 9.2%), and psychotic illnesses (1.3% vs. 1.9%). Unadjusted 30-day mortality was 6.1% for CHF and 10.6% for pneumonia; within each diagnosis mortality was similar (p>0.1) for patients with and without the psychiatric conditions. These results were similar in logistic regression models. For CHF, adjusted odds of death (95% C.I.) were 1.15 (0.97-1.36) for depression, 0.88 (0.49-1.59) for psychotic illnesses, 0.88 (0.68-1.15) for anxiety, and 0.91 (0.66-1.25) for PTSD. For pneumonia, adjusted odds were 1.08 (0.95-1.23), 0.99 (0.74-1.24), 0.93 (0.77-1.3), and 0.91 (0.73-1.34) for the four conditions, respectively.

In contrast to our hypothesis, veterans with psychiatric comorbidities did not have higher 30-day mortality after admission for two common conditions—CHF and pneumonia.

Veterans with psychiatric conditions were not at increased risk of adverse hospital outcomes. Given that patients with psychiatric illness may present unique challenges to health care providers, these findings are reassuring that providers are able to overcome these potential barriers.