Association of epilepsy with utilization and acute outcomes following cardiac surgery

PURPOSE: Despite increased recognition of cardiovascular morbidity in patients with epilepsy, the influence of epilepsy on outcomes following cardiac operations remains poorly characterized. METHODS: Adults (≥18 years) undergoing coronary artery bypass grafting (CABG), valve, or aortic procedures were identified in the 2016-2022 Nationwide Readmissions Database. Epilepsy was identified using validated International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes (G40.x) present on a prior inpatient admission or as a non-primary diagnosis on the index admission; patients with epilepsy coded as the primary admitting diagnosis were excluded to avoid misclassifying acute presentations as preexisting disease. Entropy balancing across prespecified covariates (age, sex, Elixhauser Comorbidity Index, operation type, elective admission status, insurance type) was followed by mixed-effects regression with hospital-level random effects to assess the association of epilepsy with in-hospital mortality, postoperative complications, non-home discharge, and resource utilization including 30-day readmissions. RESULTS: Of 1,932,935 adult patients undergoing cardiac operations, 27,325 (1.4%) had a preexisting diagnosis of epilepsy. On adjusted analysis, epilepsy was associated with significantly higher odds of in-hospital mortality (adjusted odds ratio [AOR]: 1.47; 95% confidence interval [CI]: 1.35-1.59), blood transfusion (AOR: 1.24; 95% CI: 1.20-1.29), infectious (AOR: 1.34; 95% CI: 1.27-1.40), and respiratory (AOR: 1.31; 95% CI: 1.26-1.37) complications. Epilepsy was also linked with prolonged hospitalization (β + 2.32 days; 95% CI: 2.12-2.47), greater costs (β + $9,121; 95% CI: 8,292-9,951), higher odds of non-home discharge (AOR: 2.01; 95% CI: 1.93-2.10), and 30-day non-elective readmission (AOR: 1.28; 95% CI: 1.21-1.34). CONCLUSIONS: Among patients undergoing cardiac operations, epilepsy was associated with increased risk of mortality, complications, and resource utilization. These findings demonstrate the need for enhanced perioperative strategies tailored to mitigate adverse events in this vulnerable population.