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

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Funding

ILL received salary support from a National Cancer Institute T32 Institutional Training Grant (5T32CA126607) and a Research Foundation of the American Society of Colon and Rectal Surgeons Resident Research Initiation Grant (GSRRIG-031) for the preparation of this manuscript. FMJ received salary support as the primary investigator of an Agency for Healthcare Research and Quality grant (1K08HS024736-01).

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Authors and Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ira L. Leeds MD, MBA, ScM, Patrick M. Meyers BA, Zachary O. Enumah MD, Jin He MD, PhD, FACS, Richard A. Burkhart MD, FACS, Elliott R. Haut MD, PhD, FACS, Jonathan E. Efron MD, FACS & Fabian M. Johnston MD, MHS, FACS

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  1. Ira L. Leeds MD, MBA, ScM
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  2. Patrick M. Meyers BA
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  3. Zachary O. Enumah MD
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  4. Jin He MD, PhD, FACS
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  5. Richard A. Burkhart MD, FACS
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  6. Elliott R. Haut MD, PhD, FACS
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  7. Jonathan E. Efron MD, FACS
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  8. Fabian M. Johnston MD, MHS, FACS
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Correspondence to Fabian M. Johnston MD, MHS, FACS.

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Disclosure

Ira L. Leeds, Patrick M. Meyers, Zachary O. Enumah, Jin He, Richard A. Burkhart, Elliott R. Haut, Jonathan E. Efron, and Fabian M. Johnston have no conflicts of interest to declare.

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Leeds, I.L., Meyers, P.M., Enumah, Z.O. et al. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Ann Surg Oncol 26, 936–944 (2019). https://doi.org/10.1245/s10434-018-07136-3

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  • DOI: https://doi.org/10.1245/s10434-018-07136-3

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