Kennedy Jensen, MD
Resident Physician
University of Utah
Salt Lake CIty, Utah, United States
Divya Sood, ND (she/her/hers)
Assistant Professor
OHSU
Portland, Oregon, United States
Joshua J. Horns, PHD
Assistant Professor
University of Utah
Salt Lake CIty, Utah, United States
Rupam Das, BS
Program Manager
University of Utah
Salt Lake CIty, Utah, United States
Adam Hanely, PHD
University of Florida
Gainsville, Florida, United States
Julie Fritz, PHD
University of Utah
Salt Lake City, Utah, United States
Erin P. Ward, MD
Assistant Professor
University of Utah
Salt Lake City, Utah, United States
Mental health (MH) has been shown to directly impact both surgical recovery and cancer outcomes. We aimed to evaluate whether comorbid mental health conditions affect short-term surgical outcomes for patients undergoing colectomy for colon cancer.
Methods:
The national claims-based Merative Marketscan database was queried for all patients undergoing colectomy for colon cancer between 2011 and 2021. Surgeries were categorized based on surgical approach (minimally invasive (MIS) or open) and creation of ostomy. We stratified patients based on the presence of a comorbid MH diagnosis and evaluated outcomes following surgery including readmission rates, Emergency Department (ED) visits, and complication rates. We used Cox proportional hazard models to calculate the effect of MH comorbidities on likelihood of 30-day and 90-day events post-surgery.
Results:
A total of 18,379 patients underwent colectomy for colon cancer with a median age of 61 (IQR 53-72) and median Charlson Comorbidity Index (CCI) of 3 (IQR 2-5). Of these, 39% (n=7122) had a comorbid MH condition, most frequently anxiety (n=5063, 28%) and depression (n=3053, 16%). Overall, the most common type of surgery was MIS colectomy without ostomy (n=10842, 59%) followed by open colectomy without ostomy (n=6687, 37%). A greater proportion of patients with a MH condition were female (59% vs. 44%, p < 0.001) and had a CCI of > 4 (50% vs. 38%, p > 0.001). Patients with an MH condition had significantly higher rates of 30-day readmissions (8% vs. 6%, p< 0.001), ED visits (9% vs. 7%, p< 0.001), and complications (4% vs. 3%, p = 0.007). This trend sustained at 90 days with the MH cohort having greater readmissions (14% vs. 10%, p< 0.001), ED visits (19% vs. 13%, p< 0.001) and complications (7% vs. 5%, p< 0.001), Figure 1. On multivariate analysis, a MH condition was associated with a 1.236 hazard ratio (HR) for readmission, 1.37 HR for ED visit, and 1.16 HR for a complication at 90 days when controlling for age, sex, surgical approach, presence of ostomy, and CCI score.
Conclusions:
Presence of a MH comorbidity is an independent risk factor for 30- and 90-day readmissions as well as complications. Future work to minimize the effects of this risk factor and optimize care for these patients is warranted.