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the Role of Comorbid Psychiatric Disorders in the Surgical Treatment of Rectal Cancer
Nicole E. Wieghard, Daniel O. Herzig, Kim C. Lu, Karen Deveney, Vassiliki L. Tsikitis*
SURGERY, OHSU, Portland, OR
Importance:
Psychiatric disorders are common in the US, but little is known about their impact on the surgical management of rectal cancer.
Objective:
To determine whether frequency of sphincter-preserving procedures and postoperative complications of rectal cancer patients differ in those with psychiatric diagnoses.
Design, Setting and Participants:
23,914 patients from the Nationwide Inpatient Sample (NIS) who underwent surgery for rectal cancer (2004 - 2011) were identified. Patients with comorbid Axis I psychiatric diagnoses were identified by ICD-9 code.
Main Outcomes Measures:
Operation performed, length of stay (LOS), postoperative complications, and discharge disposition
Results:
Twenty percent of patients had a psychiatric diagnosis, and substance use was the most common psychiatric disorder (63%). Patients with psychiatric diagnoses were more likely to be younger, white, have lower income, and have Medicaid insurance (P<0.001) than patients without psychiatric diagnoses.
Patients with any psychiatric diagnosis were less likely to have sphincter-sparing surgery (46% vs 52%, P<0.001), and this disparity persisted after logistic regression was performed controlling for patient sociodemographics, Charlson score, hospital procedure volume, and year (OR 0.77; 95% CI 0.71-0.83; P<0.001). LOS and postoperative complications were similar among the cohorts. Patients with psychiatric disorders were more likely to have home health care at discharge (P<0.001).
Conclusions and Relevance:
Fewer sphincter-sparing procedures were performed on rectal cancer patients with psychiatric diagnoses. There were, however, no significant differences in the postoperative complications.
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