Clinical Research Papers:
Psychiatric morbidity and its impact on surgical outcomes for esophageal and gastric cancer patients: A nationwide cohort study
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Huan Song1, Jianwei Zhu1, Donghao Lu1, Fang Fang1, Weimin Ye1, Lars Lundell2, Jan Johansson3, Mats Lindblad2 and Magnus Nilsson2
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
2Division of Surgery, CLINTEC, Department of Surgical Gastroenterology, Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden
3Department of Surgery, Skåne University Hospital, Lund, Sweden
Huan Song, email: [email protected]
Keywords: psychiatric morbidity, prognosis, surgery, gastric cancer, esophageal cancer
Received: March 14, 2017 Accepted: May 20, 2017 Published: June 02, 2017
Background: Due to the lack of detailed clinical information, existed evidence regarding a link between psychiatric factors and adverse cancer prognosis was inclusive.
Results: We identified 1,340 patients (48.8%) with perioperative psychiatric morbidity. Preoperative psychiatric morbidity was significantly associated with both general and surgical complications within 30 days (RR = 1.3, 95% confidence interval [CI] 1.1–1.5), and the risk of death within 90 days (RR = 1.6; 95% CI 1.1–2.2) after surgery. The hazards for mortality beyond 90 days was approximately 2-fold increased among patients with perioperative psychiatric morbidity (HR = 2.0, 95% CI 1.7–2.3 for overall mortality).
Materials and Methods: Based on the Swedish National Registry for Esophageal and Gastric cancer (NREV), we constructed a nationwide prospective cohort containing 2,745 surgically treated patients in 2006–2012. Perioperative psychiatric morbidity was defined as a clinical diagnosis of psychiatric disorder, from two years before to two years after surgery. Using propensity scores, we applied inverse probability of treatment weights (IPTW)-weighted Poisson regression model to evaluate relative risk (RR) of short-term surgical outcomes in relation to perioperative psychiatric morbidity. Further, IPTW-weighted Cox proportional hazards model was used to estimate hazard ratios (HRs) for mortality that occurred after 90 days of surgery.
Conclusions: Perioperative psychiatric morbidity could worsen both short-term and long-term surgical outcomes among patients with gastric or esophageal cancer.
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