行为健康障碍对癌症患者手术结局的影响。

Effect of Behavioral Health Disorders on Surgical Outcomes in Cancer Patients.

作者信息

Katayama Erryk S, Woldesenbet Selamawit, Munir Muhammad Musaab, Endo Yutaka, Rawicz-Pruszyński Karol, Khan Muhammad Muntazir Mehdi, Tsilimigras Diamantis, Dillhoff Mary, Cloyd Jordan, Pawlik Timothy M

机构信息

From the Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH (Katayama, Woldesenbet, Munir, Endo, Rawicz-Pruszyński, Khan, Tsilimigras, Dillhoff, Cloyd, Pawlik).

Division of Surgical Oncology, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH (Katayama).

出版信息

J Am Coll Surg. 2024 Apr 1;238(4):625-633. doi: 10.1097/XCS.0000000000000954. Epub 2024 Mar 15.

DOI:10.1097/XCS.0000000000000954

PMID:38420963

Abstract

BACKGROUND

Behavioral health disorders (BHDs) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes.

STUDY DESIGN

Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018 and 2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Postoperative textbook outcomes (ie no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed.

RESULTS

Among 694,836 cancer patients, 46,719 (6.7%) patients had at least 1 BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs BHD: 20.3%; p < 0.001). Among surgical patients, individuals with BHD had higher odds of a complication (odds ratio [OR] 1.32 [1.26 to 1.39]), prolonged length of stay (OR 1.36 [1.29 to 1.43]), and 90-day readmission (OR 1.57 [1.50 to 1.65]) independent of social vulnerability or hospital-volume status resulting in lower odds to achieve a TO (OR 0.66 [0.63 to 0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs BHD: $17,432; p < 0.001). Of note, patients with BHD had worse long-term postoperative survival (median, no BHD: 46.6 [45.9 to 46.7] vs BHD: 37.1 [35.6 to 38.7] months) even after controlling for other clinical factors (hazard ratio 1.26 [1.22 to 1.31], p < 0.001).

CONCLUSIONS

BHD was associated with lower likelihood to achieve a postoperative textbook outcome, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery.

摘要

背景

行为健康障碍（BHDs）在癌症患者中往往会加剧。我们试图确定癌症患者中BHD的患病率，并描述BHD与手术结果之间的关联。

研究设计

在医疗保险标准分析文件中确定了2018年至2021年间被诊断为肺癌、食管癌、胃癌、肝癌、胰腺癌和结直肠癌的患者。获取了定义为药物滥用、饮食失调或睡眠障碍的BHD数据。评估了术后教科书式结局（即无并发症、住院时间延长、90天再入院或90天死亡率）以及住院费用和总生存期。

结果

在694,836名癌症患者中，46,719名（6.7%）患者至少有一种BHD。患有BHD的患者接受手术切除的可能性较小（无BHD：23.4% vs BHD：20.3%；p<0.001）。在手术患者中，患有BHD的个体出现并发症的几率更高（优势比[OR]1.32[1.26至1.39]）、住院时间延长（OR 1.36[1.29至1.43]）和90天再入院几率更高（OR 1.57[1.50至1.65]），与社会脆弱性或医院规模状况无关，导致实现教科书式结局的几率较低（OR 0.66[0.63至0.69]）。患有BHD的手术患者住院费用也更高（无BHD：16,159美元 vs BHD：17,432美元；p<0.001）。值得注意的是，即使在控制了其他临床因素后，患有BHD的患者术后长期生存率更差（中位数，无BHD：46.6[45.9至46.7]个月 vs BHD：37.1[35.6至38.7]个月）（风险比1.26[1.22至1.31]，p<0.001）。