E. Vo1, S. S. Awad1,2, H. S. Tran Cao1,2, N. N. Massarweh1,2, D. S. Lee1,2, C. Y. Chai1,2 1Baylor College Of Medicine,Michael E DeBakey Department Of Surgery,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Operative Care Line,Houston, TX, USA
Introduction: Studies have shown that anxiety and depression negatively affect wound healing, surgical site infection (SSI), length of hospital stay (LOS) and adherence to medical treatment. Psychiatric disorders are also associated with worse outcomes in cancer patients due to delays in diagnosis, disparities in access to care, differential treatment and poor compliance. To determine the impact of psychiatric disorders on short-term clinical outcomes in colorectal cancer patients, we reviewed our institutional data.
Methods: A retrospective review of colorectal surgery database at a single institution was performed between Oct 2013 to Sep 2016. Patients who underwent a surgical treatment for left colon or rectal cancer were selected. Demographics, presence of psychiatric disorders not including substance abuse or dementia, SSI, anastomotic leak, LOS, cancer stage at diagnosis, 30-day readmission and delay in adjuvant therapy (>60 days) were reviewed. Variables between patients with psychiatric disorders and those without were compared using univariate analysis with significance set at p <0.05.
Results: A total of 100 patients met our criteria. 41 patients had a documented psychiatric disorder at the time of preoperative visit. The most common diagnoses were depression, anxiety and post-traumatic disorder. No significant differences were noted between two groups regarding age, race, BMI, preoperative serum albumin, cancer stage at diagnosis, surgical approach (open vs minimally invasive), SSI, LOS, readmission, and delay in adjuvant therapy. However, patients with psychiatric disorders had a higher ASA score (p=0.04) and a greater rate of anastomotic leak rate (15% vs 0%, p=0.004)
Conclusion: A significant number of patients were already suffering from psychiatric disorders when presenting with a colorectal cancer diagnosis in this veteran patient population. Even though the short-term clinical outcomes appeared similar between two groups, the anastomotic leak rate was higher in patients with psychiatric conditions. Multimodal prehabilitation including a psychological component may improve clinical outcomes and identify high-risk patients. In addition, further investigation should be made examining long-term oncological outcomes in these patients.