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Women in Thoracic Surgery

PS66. Serious Mental Illness Prolongs Hospital Admission Following Lung Cancer Resection

May 6, 2023

103rd Annual Meeting, the Los Angeles Convention Center, Los Angeles, CA, USA
Los Angeles Convention Center, Outside of Room 408
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Objective: Serious mental illness (SMI) is associated with increased complications and worse outcomes in a variety of diseases; however, SMI as a risk factor in thoracic surgery patients is incompletely understood. We hypothesized that comorbid SMI would impact mortality and morbidity following lung cancer resection.
Methods: We identified 501 patients at our institution who underwent anatomic lung cancer resection, including segmentectomy, lobectomy, bilobectomy, and pneumonectomy. Patients with comorbid SMI were identified using natural language processing (NLP)-assisted chart review and stratified into mood, anxiety and psychosis disorders. The primary outcome was a composite of postoperative complications. We analyzed the risk-adjusted impact of SMI on composite morbidity and mortality and LOS using multivariable logistic regression and Poisson regression analysis, respectively.
Results: Patients with SMI were younger, more frequently female and more likely to have a smoking history (p < 0.05, Table 1). Among identified patients, 186 (37.1%) had comorbid serious mental illness which were predominantly mood disorders (168/186, 90.3%). Overall, 116 patients (23.1%) had the primary outcome of composite postoperative mortality or morbidity. Following multivariable risk adjustment, patients with and without SMI did not have significantly different morbidity and mortality [odds ratio (OR) 1.36, 95% confidence interval (CI) 0.86-2.15]. Individually, mood disorders (OR 1.23, 95% CI 0.70-2.14), anxiety disorders (OR 1.11, 95% CI 0.58-2.10) and psychosis disorders (OR 1.70, 95% CI 0.60-4.54) did not significantly contribute to postoperative morbidity or mortality. Mean length of stay was longer in patients with SMI (7.16 days) than in patients without SMI (5.91 days). After adjusting for type of procedure and other covariates, LOS was significantly longer among patients with SMI (risk ratio 1.22, 95% CI 1.13-1.31). SMI was not associated with the extent of resection performed.
Conclusions: SMI is a risk factor for poor postoperative outcomes. In a 7.5-year period from a single academic institution, patients undergoing lung cancer resection had high rates of SMI and patients with SMI had significantly longer admissions. Future work should design and test interventions to optimize perioperative and post-discharge care for patients with SMI.

J. Nathaniel Diehl (1), Audrey Khoury (2), Julia Brickey (1), Gita Mody (2), Benjamin Haithcock (2), Jason Long (2), (1) University of North Carolina School of Medicine, Chapel Hill, North Carolina, (2) Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina

John Diehl

Poster Presenter

Nate is a fourth-year medical student at the University of North Carolina in Chapel Hill and will be pursuing General Surgery residency at Penn Surgery beginning in 2023. He joined UNC in 2015 as a combined MD/PhD student and was awarded his PhD in Genetics and Molecular Biology in 2021 for his thesis work focused on understanding kinase signaling in KRAS-mutant tumors.

Specialties: General Thoracic, Thoracic, Perioperative Management/Critical Care, Anatomy and Conditions, Lung--Cancer, Treatment/Procedure/Operation/Surgery, Lung--Cancer