Psych News Alert: Psychiatric Diagnoses Prior to Colorectal Cancer Surgery Associated With Worse Outcomes

Patients with psychiatric diagnoses who undergo colorectal cancer surgery may be at increased risk for postoperative complications and readmission within 90 days, but psychiatric treatment prior to surgery may help to reduce these risks, according to a study published Tuesday in Psychiatric Services.

“Mental health problems among surgical patients remain understudied, but data suggest that they may represent an underappreciated risk factor for poor preoperative outcomes and that they may be responsive to preoperative treatment,” wrote Chelsea G. Ratcliff, Ph.D., and Nader N. Massarweh, M.D., of Baylor College of Medicine in Houston and colleagues.

The researchers used data from the Veterans Health Administration’s Patient Care Services database, which captures health care encounters, and the U.S. Department of Veterans Affairs Surgical Quality Improvement Program, which measures and provides feedback on the quality of surgical care before and after surgery. From 2000 to 2014, 58,961 patients underwent colon or rectal surgery for colon or rectal cancer.

In total, 15.3% of the patients had a psychiatric diagnosis before surgery, the most common of which were substance use disorders, depression, posttraumatic stress disorder, and anxiety. Of those patients, 49% received no psychiatric treatment in the 30 days before surgery.

Findings include the following:

• Patients with psychiatric diagnoses who received no psychiatric treatment or only medication treatment had a 7% to 17% increased risk for postoperative complications compared with patients with no psychiatric diagnosis.
• Patients who were treated with medication only had a 4% increase in length of stay relative to patients with no psychiatric diagnosis. Length of stay did not differ between patients with psychiatric diagnoses who received psychotherapy only, both medication and psychotherapy, or no treatment and patients with no psychiatric diagnosis.
• Patients with a psychiatric diagnosis who received only psychotherapy treatment or both medication and psychotherapy did not significantly differ from patients with no psychiatric diagnosis in terms of complications.
• Substance use disorders were associated with an increased risk for postoperative complications; depression and psychotic disorders were associated with longer length of stay; and depressive, posttraumatic stress, and substance use disorders were associated with an increased risk for 90-day readmission.

“[T]he findings of this study suggest that the risk associated with a psychiatric diagnosis may partially depend on preoperative mental health treatment,” the authors wrote. “Careful screening for mental health concerns during preoperative appointments may help identify patients at risk for postoperative complications and readmissions.”

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