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Kolba et al. Vessel Plus 2023;7:12 https://dx.doi.org/10.20517/2574-1209.2022.61 Page 11 of 13

Based on hospital inpatient and outpatient, ambulatory surgery, and emergency room SPARCS records, this
study’s STS post-procedural outcomes were limited to those occurring within 30 days post-procedure.
Several studies, as outlined below, identify MEI as a risk factor for poor long-term postoperative outcomes.
Historically, patients with depression and/or anxiety have had worse long-term surgical outcomes
compared to the general population. For example, depression was shown to be a risk factor for 10-12-year
mortality following coronary artery bypass surgery [29-31] . Aside from increasing rates of postoperative
mortality, mental illness also increases the chance of emergency readmission as well as overall greater
[32]
postoperative pain and worse physical symptoms . Even after a minimally invasive procedure such as
TAVR, patients with dementia were seen to have higher rates of in-hospital delirium as well as discharge to
[33]
rehabilitation facilities . Thus, follow up beyond 30 days may be required to identify any MEI-related risk-
adjusted outcome differences.

Limitations
Observational research study designs using administrative databases are inherently limited to the
information that is available as well as the potential confounding of unmeasured variables. During this New
York State SPARCS analysis, moreover, the lower-than-expected MEI proportion of patients receiving AVR
and r-AVR procedures seems suggestive of either a potential differential referral or selection process being
applied to MEI patients being evaluated for these cardiac procedures. Given these limitations, therefore,
additional research using a larger patient cohort that includes longer-term outcomes now appears
warranted to evaluate the post-procedural impacts for this vulnerable, “at risk” MEI patient population.

Conclusion
Multivariable regression analysis of the SPARCS database showed that MEI patients did not have significant
differences in their risk-adjusted POAF, 30-day readmissions, and 30-day composite endpoint rates
compared to patients without MEI after undergoing AVR and r-AVR. Although MEI patients included
younger women with multiple comorbidities, these inherently higher-risk AVR and r-AVR MEI
populations did not have significant differences in their risk-adjusted POAF, 30-day readmissions, and 30-
day composite endpoint rates. Compared to non-MEI patients, however, MEI patients more frequently
received transcatheter rather than open surgical procedures.

DECLARATIONS
Acknowledgments
Special thanks are sent to the Stony Brook University Renaissance School of Medicine’s Department of
Surgery Division of Cardiothoracic Surgery staff (Ms. Kathleen O’Brien) and Scholarly Concentrations
Programs Research Track staff (Dr. Howard Fleit and Ms. Rhonda Kearns) for their administrative
oversight and support. Additionally, our team acknowledges the biostatistical consultation and analytical
support provided by the Biostatistical Consulting Core (Dr. Jie Yang and Ms. Xiaoyue Zhang) at the
Renaissance School of Medicine, Stony Brook University.

Authors’ contributions
Substantive intellectual contribution: Kolba N, Dokko J, Novotny S, Agha S, Yaligar A, Parikh PB, Pryor
AD, Tannous HJ, Shroyer AL, Bilfinger T
Study conception and design: Kolba N, Dokko J, Novotny S, Tannous HJ, Shroyer AL, Bilfinger T
Data coding/acquisition: Kolba N, Dokko J, Novotny S, Agha S, Yaligar A, Parikh PB, Pryor AD, Bilfinger
T, Shroyer AL
Data analysis/interpretation: Kolba N, Shroyer AL, Bilfinger T
Writing the initial abstract/manuscript: Kolba N, Shroyer AL, Bilfinger T