Diehl J Nathaniel, Khoury Audrey L, Brickey Julia A, Awe Adam M, Agala Chris B, Mody Gita N, Haithcock Benjamin E, Gerkin Jonathan S, Long Jason M
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Department of Surgery, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
J Thorac Dis. 2024 Dec 31;16(12):8450-8460. doi: 10.21037/jtd-24-762. Epub 2024 Dec 28.
Serious mental illness (SMI) is associated with increased complications and worse outcomes in a variety of surgical diseases, however, SMI as a risk factor in thoracic surgery patients is incompletely understood. We aimed to investigate if comorbid SMI would impact mortality and morbidity following lung cancer resection.
We identified 615 patients from the Society of Thoracic Surgery (STS) database at the University of North Carolina - Chapel Hill (January 2013-June 2021) who underwent lung cancer resection for non-small cell lung cancer (NSCLC). Patients identified with comorbid SMI as defined in prior studies were identified and stratified into mood, anxiety, and psychosis disorders. We analyzed the risk-adjusted impact of SMI on composite morbidity and mortality and length of stay (LOS) using multivariable logistic regression and Poisson regression analysis, respectively.
Patients with SMI were younger, more frequently female, and more likely to be a smoker. Among identified patients, 186 (37.1%) had comorbid SMI which were predominantly mood disorders (90.3%). Overall, 116 patients (23.2%) 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]. After adjusting for surgery performed and other covariates, LOS was significantly longer among patients with SMI [risk ratio (RR) =1.21; 95% CI: 1.13-1.30].
In a 7.5-year period from a single academic institution, patients undergoing lung cancer resection had high rates of SMI. While no difference in composite morbidity and mortality was demonstrated, patients with SMI had significantly longer LOS.
严重精神疾病（SMI）与多种外科疾病的并发症增加及预后较差相关，然而，SMI作为胸外科手术患者的一个风险因素，目前尚未被完全了解。我们旨在研究合并SMI是否会影响肺癌切除术后的死亡率和发病率。
我们从北卡罗来纳大学教堂山分校的胸外科医师协会（STS）数据库中（2013年1月至2021年6月）识别出615例行非小细胞肺癌（NSCLC）切除术的患者。根据先前研究中定义的标准，识别出合并SMI的患者，并将其分为情绪障碍、焦虑障碍和精神障碍。我们分别使用多变量逻辑回归和泊松回归分析，分析了SMI对综合发病率、死亡率和住院时间（LOS）的风险调整影响。
合并SMI的患者更年轻，女性比例更高，且更有可能是吸烟者。在已识别的患者中，186例（37.1%）合并SMI，主要为情绪障碍（90.3%）。总体而言，116例患者（23.2%）出现了术后综合死亡率或发病率的主要结局。经过多变量风险调整后，合并SMI和未合并SMI的患者在发病率和死亡率方面没有显著差异[比值比（OR）=1.36；95%置信区间（CI）：0.86-2.15]。在调整手术操作和其他协变量后，合并SMI的患者住院时间显著更长[风险比（RR）=1.21；95%CI：1.13-1.30]。
在一所单一学术机构的7.5年期间，接受肺癌切除术的患者中SMI发生率较高。虽然在综合发病率和死亡率方面没有差异，但合并SMI的患者住院时间显著更长。
