K. F. Angell1, V. P. Ho1, N. K. Schiltz2, A. P. Reimer3, E. Madigan3, S. R. Steele1, S. M. Koroukian2 1Case Western Reserve University School Of Medicine,Department Of Surgery,Cleveland, OH, USA 2Case Western Reserve University School Of Medicine,Department Of Epidemiology And Biostatistics,Cleveland, OH, USA 3Case Western Reserve University School Of Medicine,Frances Payne Bolton School Of Nursing,Cleveland, OH, USA
Introduction:
Underlying psychiatric conditions may affect outcomes of comorbid conditions due to confusion or inconsistencies in both diagnosis and treatment. We hypothesized that patients with psychiatric illness (PSYCH) would have evidence of advanced disease at presentation, as manifested by higher rates of colorectal resection performed in the presence of obstruction, perforation, or peritonitis (OPP-resection).
Methods:
Using data from the 2007-2011 National Inpatient Sample (NIS), we identified patients 65 years of age or older with a diagnosis of CRC undergoing colorectal resection. In addition to somatic comorbid conditions flagged in the NIS, we used the Clinical Classification Software to identify patients with PSYCH, including schizophrenia, delirium/dementia, developmental disorders, alcohol/substance abuse, and other psychiatric conditions. Our study outcome was OPP-resection. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to analyze the independent association between each of the PSYCH conditions and OPP-resection, after adjusting for patient demographics and somatic comorbidities.
Results:
Our study population included 60,147 patients with CRC and undergoing colorectal cancer resection, of whom 17.2% were 85 years of age or older, 51.9% were women, and 8.9% had 5 or more comorbid conditions. Nearly 17% presented with PSYCH. The percent of patients undergoing OPP-resection was 15.1% in the study population, but significantly higher in patients psychiatric diagnosed with schizophrenia (18.9%), delirium/dementia (18.9%), and alcohol/substance abuse (19.6%). Findings from the multivariable analysis showed that these associations were relatively modest and at borderline statistical significance. The odds ratios and 95% Confidence Interval were 1.24 (1.00, 1.54), 1.13 (1.02, 1.24), and 1.21 (1.05, 1.40), respectively for the aforementioned PSYCH conditions.
Conclusion:
Patients with PSYCH may have obstacles to receiving optimal care for CRC. Those with select PSYCH diagnoses had significantly higher rates of OPP-resection albeit to a relatively modest extent. It is important to note, however, that our study could not account for CRC patients who did not undergo surgery and were referred directly to hospice upon presenting with obstruction, perforation, or peritonitis. Additional evaluation is required to identify the association between PSYCH and related factors affecting the rates of emergency surgery in patients with CRC.