Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients

Background The specific effect of psychosocial risk factors on surgical outcomes in cancer patients remains unexplored. The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery. Metho...

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Bibliographic Details
Published in:Annals of surgical oncology 2019-04, Vol.26 (4), p.936-944
Main Authors: Leeds, Ira L., Meyers, Patrick M., Enumah, Zachary O., He, Jin, Burkhart, Richard A., Haut, Elliott R., Efron, Jonathan E., Johnston, Fabian M.
Format: Article
Language:English
Subjects:
Aged
Cancer
Cancer surgery
Comorbidity
Elective Surgical Procedures - adverse effects
Female
Follow-Up Studies
Gastrointestinal Neoplasms - pathology
Gastrointestinal Neoplasms - psychology
Gastrointestinal Neoplasms - surgery
Health Services Research and Global Oncology
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Population studies
Postoperative Complications - etiology
Prognosis
Prospective Studies
Risk assessment
Risk Factors
Stress, Psychological - complications
Surgery
Surgical Oncology
Surgical outcomes
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Summary:Background The specific effect of psychosocial risk factors on surgical outcomes in cancer patients remains unexplored. The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery. Methods Psychosocial risks among elective gastrointestinal cancer surgery patients were ascertained through structured interviews using well-established screening forms. We then collected postoperative course by chart review. Multivariable analysis of short-term surgical outcomes was performed in those with a low versus high number of psychosocial risks. Results Overall, 142 patients had a median age of 65 years (interquartile range 55–71), 55.9% were male, and 23.1% were non-White. More than half (58.2%) of the study population underwent a resection for a hepato-pancreato-biliary primary tumor, and 31.9% had a colorectal primary tumor. High-risk biomedical comorbidities were present in 43.5% of patients, and three-quarters of patients (73.4%) had at least one psychosocial risk. Complication rates in patients with at least one psychosocial risk were 28.0 absolute percentage points higher than those with no psychosocial risks (54.4% vs. 26.2%, p   =  0.039). Multiple psychosocial risk factors in medically comorbid patients independently conferred an increase in the odds of a complication by 3.37-fold (95% CI 1.08–10.48, p   =  0.036) compared with those who had one or no psychosocial risks. Conclusions We demonstrated a more than threefold odds of a complication in medically comorbid patients with multiple psychosocial risks. These findings support the use of psychosocial risks in preoperative assessment and consideration for inclusion in preoperative optimization efforts.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-018-07136-3