Longer Hospitalizations, More Complications, and Greater Readmissions for Patients with Comorbid Psychiatric Disorders Undergoing Pulmonary Lobectomy.

May 29, 2023

Experts: Alexander T Kim,Li Ding,Hochang B Lee,Matthew J Ashbrook,Arman Ashrafi,Sean C Wightman,Scott M Atay,Elizabeth A David,Takashi Harano,Anthony W Kim

To examine the impact of comorbid psychiatric disorders on postoperative outcomes in pulmonary lobectomy patients.
A retrospective analysis of the Healthcare Cost and Utilization Project Nationwide Readmissions Database from 2016-2018 was performed. Lung cancer patients with and without psychiatric comorbidities who underwent pulmonary lobectomy were collated and analyzed (International Classification of Diseases, 10 Revision, Clinical Modification (ICD-10-CM) Mental, Behavioral and Neurodevelopmental disorders (F01-99; PSYD)). The association of PSYD with complications, length of stay (LOS), and readmissions was assessed using a multivariable regression analysis. Additional subgroup analyses were performed.
41,691 patients met inclusion criteria. 27.84% (11,605) of the patients had at least one PSYD. PSYD was associated with a significantly increased risk of postoperative complications (RR 1.041; 95% CI: 1.015-1.068; p=0.0018), pulmonary complications (RR 1.125; 95% CI: 1.08-1.171; p<0.0001), longer LOS (PSYD Mean – 6.79 days; Non-PSYD Mean – 5.68 days; p<0.0001), higher 30-day readmission rate (9.2% vs. 7.9%; p<0.0001), and 90-day readmission rate (15.4% vs. 12.9%; p<0.007). Among PSYD, those with cognitive disorders and psychotic disorders (e.g. schizophrenia) appear to have highest rates and risks of post-operative morbidity and in-hospital mortality.
Lung cancer patients 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.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Alexander T Kim,Li Ding,Hochang B Lee,Matthew J Ashbrook,Arman Ashrafi,Sean C Wightman,Scott M Atay,Elizabeth A David,Takashi Harano,Anthony W Kim

Alexander T Kim

Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Li Ding

Division of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Hochang B Lee

Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY.

Matthew J Ashbrook

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Arman Ashrafi

Keck School of Medicine of the University of Southern California, Los Angeles, CA.

Sean C Wightman

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Scott M Atay

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Elizabeth A David

Division of Thoracic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.

Takashi Harano

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Anthony W Kim

Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA; Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: anthony.kim@med.usc.edu.