Thoracic: Lung Cancer: Perioperative Management
Longer hospitalizations, more complications, and greater readmissions for patients with comorbid psychiatric disorders undergoing pulmonary lobectomy

Read at The American Association for Thoracic Surgery International Thoracic Oncology Summit 2022, New York, New York, September 30-October 1, 2022.
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Abstract

Objective

To examine the influence of comorbid psychiatric disorders (PSYD) on postoperative outcomes in patients undergoing pulmonary lobectomy.

Methods

A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2016 to 2018 was performed. Patients with lung cancer with and without psychiatric comorbidities who underwent pulmonary lobectomy were collated and analyzed (International Classification of Diseases, 10th Revision, Clinical Modification Mental, Behavioral and Neurodevelopmental disorders [F01-99]). The association of PSYD with complications, length of stay, and readmissions was assessed using a multivariable regression analysis. Additional subgroup analyses were performed.

Results

A total of 41,691 patients met inclusion criteria. Of these, 27.84% (11,605) of the patients had at least 1 PSYD. PSYD was associated with a significantly increased risk of postoperative complications (relative risk, 1.041; 95% CI, 1.015-1.068; P = .0018), pulmonary complications (relative risk, 1.125; 95% CI, 1.08-1.171; P < .0001), longer length of stay (PSYD mean, 6.79 days and non-PSYD mean, 5.68 days; P < .0001), higher 30-day readmission rate (9.2% vs 7.9%; P < .0001), and 90-day readmission rate (15.4% vs 12.9%; P < .007). Among patients with PSYD, those with cognitive disorders and psychotic disorders (eg, schizophrenia) appear to have the highest rates and risks of postoperative morbidity and in-hospital mortality.

Conclusions

Patients with lung cancer with comorbid psychiatric disorders undergoing lobectomy experience worse postoperative outcomes with longer hospitalization, increased rates of overall and pulmonary complications, and greater readmissions suggesting potential opportunities for improved psychiatric care during the perioperative period.

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.

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