Impact of schizophrenia on coronary artery bypass grafting outcomes: a nationwide analysis

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Background: Schizophrenia is associated with an elevated cardiovascular disease burden and mortality. However, outcomes for patients with schizophrenia undergoing coronary artery bypass grafting (CABG) remain poorly characterized. We investigated perioperative outcomes, resource utilization, and discharge disposition in this vulnerable population. Methods: Using the National Inpatient Sample (2017–2020), we identified 773 925 adult CABG admissions, including 2250 patients with schizophrenia and 771 675 without. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospital charges, post-operative complications, and discharge disposition. Multivariable logistic and linear regression models were adjusted for demographics, comorbidities, and hospital characteristics. Results: Patients with schizophrenia were younger (59.6 vs 66.3 years, P < 0.001), had a higher comorbidity burden (Charlson index 3.1 vs 2.7, P < 0.001), and a greater prevalence of diabetes (58.0% vs 51.1%, P < 0.0001), tobacco use (41.6% vs 18.4%, P < 0.001), and prior myocardial infarction (21.6% vs 17.5%, P < 0.001). After adjustment, schizophrenia was associated with increased odds of in-hospital mortality of borderline statistical significance (adjusted OR 1.30, 95% CI 1.001–1.69, P = 0.049), prolonged hospitalization (1.74 additional days, 95% CI 1.40–2.04, P < 0.0001), and discharge to skilled nursing facilities (adjusted OR 1.74, 95% CI 1.33–2.27, P < 0.0001). Post-operative infection, stroke, and bleeding rates were similar between groups. Conclusions: Schizophrenia was associated with increased odds of in-hospital mortality of borderline statistical significance (adjusted OR 1.30, 95% CI 1.001–1.69, P = 0.049), prolonged hospitalization, and a greater need for post-acute skilled nursing care following CABG. These findings highlight the need for integrated perioperative psychiatric care, optimized perioperative protocols, and structured discharge planning to improve outcomes and ensure equitable care for patients with serious mental illness undergoing cardiac surgery.

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