Are patients with coexisting mental disorders more likely to receive CABG surgery from low-quality cardiac surgeons? The experience in New York State

Abstract

Background: Presence of a mental disorder has been shown to be associated with reduced access to medical and surgical services. Little is known, however, about the relationship between mental disorders and the quality of medical/surgical care received.

Methods: We analyzed New York State hospital discharge data between 2001 and 2003 and New York's publicly-released Cardiac Surgery Report of surgeons' risk-adjusted mortality rate, to evaluate whether differences exist between persons with and without mental disorders (specifically, psychiatric and/or substance-use disorders) in receiving care from low-quality and high-quality surgeons performing coronary artery bypass graft (CABG) surgeries.

Results: Controlling for individual demographic, socioeconomic, and clinical characteristics, persons with any mental disorder (n = 3211) were more likely than others (n = 36,628) to be treated by low-quality cardiac surgeons (odds ratio [OR] = 1.28, P = 0.023), whose reported risk-adjusted mortality rates were significantly higher than the state average CABG mortality rate. Compared with patients without mental disorders, patients with psychiatric disorders (n = 2651) showed an increased likelihood of being treated by these low-quality surgeons (OR = 1.36, P = 0.008). In addition, patients with both substance-use and psychiatric disorders (n = 113), but not substance-use alone (n = 447), were more likely to receive care from surgeons in the high-mortality quintile group (OR = 1.76, P = 0.024). There was no significant association between each type of mental disorders and the likelihood of being treated by a low-mortality, high-quality cardiac surgeon.

Conclusions: New York State patients with mental disorders, especially psychiatric disorders, are more likely to receive CABG surgery from low-quality cardiac surgeons. No evidence suggests that these patients are disadvantaged in access to high-quality cardiac surgeons.