The Journal of Thoracic and Cardiovascular Surgery
Thoracic: Lung Cancer: Perioperative ManagementLonger hospitalizations, more complications, and greater readmissions for patients with comorbid psychiatric disorders undergoing pulmonary lobectomy
Graphical abstract
Section snippets
Data Source
This study was a retrospective cohort analysis of patients who underwent pulmonary lobectomy from 2016 to 2018. Data was sourced from the Healthcare Utilization Project Nationwide Readmission Database (HCUP-NRD), which is sponsored by the Agency for Healthcare Research and Quality. The HCUP-NRD is the largest publicly available inpatient care database that contains data on approximately 18 million hospital discharges annually and includes patients covered by Medicare, Medicaid, private
Baseline Patient and Hospital Characteristics
A total of 41,691 fulfilled inclusion criteria. Demographic variables and hospital characteristics from the study population can be seen in Table 1. Overall, 70.9% possessed a smoking history with a greater proportion of smokers in the PSYD cohort (PSYD, 75.3% vs non-PSYD, 69.2%; P < .0001).
Of the 3 surgical approaches, the majority was performed via the open (41.4%) and VATS approach (40.3%). Median LOS based on approach were: open = 6 days (IQR, 4-8 days), VATS = 4 days (IQR, 3-6 days), and
Discussion
This study uses a contemporary dataset of patients with lung cancer who underwent pulmonary lobectomy to examine the association of PSYD and adverse outcomes. The results demonstrate increased complications (particularly pulmonary complications), higher 30-day/90-day readmissions, and prolonged LOS in patients with PSYD compared with non-PSYD. Notably, cognitive disorders (eg, dementia) and psychotic disorders (eg, schizophrenia) had significantly higher odds of in-hospital mortality.
Although
Conclusions
These findings identify lung cancer patients with PSYD as a potentially vulnerable, at-risk surgical patient population. Understanding the influence of psychiatric disorders on surgical outcomes appears vital for thoracic surgeons. Although surgeons utilize risk-stratification strategies and optimization tools to aid in their decision-making process, these traditional methods have focused almost exclusively on the patient's physical health rather than incorporating and assessing mental health.31
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This study is supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.