P. M. Meyers1, I. L. Leeds1, E. R. Haut1, J. E. Efron1, Z. O. Enumah1, F. M. Johnston1 1Johns Hopkins University School Of Medicine,Baltimore, MD, USA
Introduction: Cancer surgery is known to carry additional risks compared to other surgical procedures and is often paired with comorbid therapies such as radiation and chemotherapy. Certain behavioral traits and inadequate social support may be risk factors for complications following cancer surgery. While psychosocial risk factors are often discussed in the context of cancer care, it is unclear if the medical record accurately captures them.
Methods: In this study, adult surgical patients at a tertiary academic medical center were interviewed using validated risk screening instruments prior to curative abdominal cancer surgery. The questionnaire assessed 11 psychosocial risk factors including resilience, resourcefulness, substance abuse, and mental health. These same risk factors were assessed by retrospective chart review up to six months prior to surgery and compared to survey results. Concordance was calculated using positive and negative agreement and Cohen’s Kappa. Those positive by questionnaire but not the medical record were categorized as “clinically missed.” 30-day postoperative complications were abstracted from each patient’s medical record. Complication rates for those with and without missed psychosocial risk factors were statistically compared using Fisher’s exact test.
Results: We identified 57 eligible patients (61% male, median age of 65, IQR 55-72). Among those, 63% were identified as having 1 or more psychosocial risk factors by questionnaire while only 41% by chart review. Comparisons between chart review and patient survey revealed poor positive agreement among 9 of 11 risk factors (0-17%) and moderate agreement among 2 of 11 for depression (50%) and smoking status (75%). All showed excellent negative agreement (83-100%). Kappa analysis demonstrated poor-to-fair agreement among 10 of 11 risk factors (κ = 0 to 0.344). Finalized 30-day outcomes were available for 40 patients with an overall complication rate of 37%. Seven of 11 psychosocial risk factors demonstrated a consistent nonsignificant trend for those with missed risk factors to have higher complication rates than those without (Figure). The complication rate for patients with at least one clinically missed psychosocial risk factor was 59% versus 17% in those without (p=0.015).
Conclusion: This study suggests a high level of discordance between formal screening and routine clinician interviewing and documentation for psychosocial risk factors. There is an association between missed risk factors and worse post-operative outcomes. Further work should demonstrate whether structured screening and documenting of psychosocial risk factors may better risk stratify patients preoperatively to allow for early intervention.
