Association of epilepsy with utilization and acute outcomes following cardiac surgery

Q: What are the key findings of this study?

Preexisting epilepsy was associated with higher odds of in-hospital mortality (AOR 1.47, 95% CI 1.35–1.59) and postoperative complications in adults undergoing cardiac surgery.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Adults undergoing cardiac surgery (CABG, valve, or aortic procedures) (n=1932935). Intervention: Preexisting epilepsy vs. No preexisting epilepsy. Primary outcome: In-hospital mortality (OR 1.47, 95% CI 1.35-1.59, p=<0.05).

Q: What does this research mean for the field?

Preexisting epilepsy is associated with significantly increased odds of in-hospital mortality, postoperative complications, and healthcare resource utilization in adults undergoing cardiac surgery. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association of preexisting epilepsy with in-hospital mortality, postoperative complications, non-home discharge, and resource utilization among adults undergoing cardiac operations.

Konmal Ali; Syed Shaheer Ali; Troy N. Coaston; Sona Mahrokhi; Peyman Benharash

doi:10.1371/journal.pone.0359534

October 30, 2026PLoS ONEOpen Access

Association of epilepsy with utilization and acute outcomes following cardiac surgery

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Key result

Preexisting epilepsy is linked to ~47% higher in-hospital mortality after cardiac surgery.

OR 1.47
95% CI 1.35-1.59
P<0.05
n=1,932,935

Why the study?

Despite increased recognition of cardiovascular morbidity in patients with epilepsy, the influence of epilepsy on outcomes following cardiac operations remained poorly characterized.

Does a preexisting diagnosis of epilepsy increase the risk of in-hospital mortality, postoperative complications, and resource utilization in adults undergoing cardiac operations?

Key Points

To evaluate the association of preexisting epilepsy with in-hospital mortality, postoperative complications, non-home discharge, and resource utilization among adults undergoing cardiac operations.
Identified adults (≥18 years, N=1,932,935) undergoing coronary artery bypass grafting, valve, or aortic procedures in the 2016–2022 Nationwide Readmissions Database.
Identified preexisting epilepsy via ICD-10 diagnosis codes (G40.x) on prior admissions or as a secondary diagnosis on index admission (n=27,325; 1.4%).
Applied entropy balancing across demographic and clinical covariates, followed by mixed-effects regression with hospital-level random effects.
Epilepsy was associated with significantly higher odds of in-hospital mortality (4.7% vs 2.9%; AOR: 1.47; 95% CI: 1.35–1.59).
Patients with epilepsy had greater odds of blood transfusion (24.5% vs 19.4%; AOR: 1.24; 95% CI: 1.20–1.29), infectious (15.4% vs 9.7%; AOR: 1.34; 95% CI: 1.27–1.40), and respiratory complications (17.9% vs 12.9%; AOR: 1.31; 95% CI: 1.26–1.37).
Epilepsy was linked to prolonged hospitalization (β + 2.32 days; 95% CI: 2.12–2.47), increased costs (β + $9,121; 95% CI: 8,292−9,951), non-home discharge (27.8% vs 16.6%; AOR: 2.01; 95% CI: 1.93–2.10), and 30-day non-elective readmission (13.7% vs 10.0%; AOR: 1.28; 95% CI: 1.21–1.34).

Study Design

Type

Cohort (n=1,932,935)

Multicenter

Yes

Structured PICO

Does a preexisting diagnosis of epilepsy increase the risk of in-hospital mortality, postoperative complications, and resource utilization in adults undergoing cardiac operations?

P

Population

1,932,935 adult hospitalizations (≥18 years; ~28.7% female) undergoing CABG, valve, or aortic surgery in the United States from 2016 to 2022, followed through index hospitalization and 30 days post-discharge.

E

Exposure

Preexisting diagnosis of epilepsy (identified using validated ICD-10 diagnosis codes G40.x present on a prior inpatient admission or as a non-primary diagnosis on the index admission) among patients undergoing cardiac surgery.

C

Comparator

Patients without a diagnosis of epilepsy undergoing cardiac operations, matched via entropy balancing across age, sex, Elixhauser Comorbidity Index, elective admission status, operation type, insurance type, hospital volume, and hospital teaching status.

O

Outcome

Adjusted in-hospital mortality and the development of postoperative complications (cardiac, infectious, respiratory, neurologic, renal, thromboembolic, and blood transfusion) during the index hospitalization.hard clinical

Main Result

Odds Ratio: 1.47 (95% CI 1.35–1.59)

Absolute Event Rate: 4.7% vs 2.9%

p-value: p=<0.05

In a large national cohort of patients undergoing cardiac surgery, preexisting epilepsy is independently associated with a 47% higher odds of in-hospital mortality, elevated postoperative complications, longer hospital stays, higher costs, and increased 30-day readmissions.

Limitations

Reliance on administrative hospital billing and ICD-10 diagnostic coding practices, which may introduce variability in case identification and outcome ascertainment.
Lack of granular clinical information such as epilepsy severity, seizure duration or frequency, antiepileptic medication regimens, laboratory values, operative complexity, or imaging findings.
Inability to differentiate between active and well-controlled epilepsy.
Inability to track patients across state lines or beyond a single calendar year in the Nationwide Readmissions Database, potentially undercounting readmissions.
Subgroup analyses were not conducted due to the relatively small sample size of the epilepsy cohort.
Relies on hospital billing and diagnostic coding practices in an administrative database, which may introduce variability in case identification and outcome ascertainment
Does not capture granular clinical information such as epilepsy severity, duration, or frequency of seizures, antiepileptic medication regimens, laboratory values, operative complexity, or imaging findings
Inability to differentiate between active and well-controlled epilepsy
Does not allow tracking of patients across state lines or beyond a single calendar year, which may result in undercounting of readmissions and limit longer-term follow-up
Subgroup analyses were not conducted due to the small sample size of the epilepsy cohort

Implication

May inform preoperative risk counseling for epilepsy patients; leaves open whether targeted interventions improve cardiac surgical outcomes.

Abstract

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.

Discussion

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Cite This Study

Ali et al. (2026) conducted a cohort in Adults undergoing cardiac surgery (CABG, valve, or aortic procedures) (n=1,932,935). Preexisting epilepsy vs. No preexisting epilepsy was evaluated on In-hospital mortality (OR 1.47, 95% CI 1.35-1.59, p=<0.05). Preexisting epilepsy was associated with higher odds of in-hospital mortality (AOR 1.47, 95% CI 1.35–1.59) and postoperative complications in adults undergoing cardiac surgery.

synapsesocial.com/papers/6ae682bde432e7a5c4ef372d https://doi.org/10.1371/journal.pone.0359534

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Association of epilepsy with utilization and acute outcomes following cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of epilepsy with utilization and acute outcomes following cardiac surgery

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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