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Incidence of Psychiatric Disorders Rapidly Rising and Associated with Reduced Perioperative and Long-Term Survival: A General Thoracic Surgery Database-Medicare Linked Study
精神病性障碍（psychotic disorder）
精神障碍 Psychiatric disorders (PDs)，在本文包括：PDs included depressive, anxiety, psychotic, alcohol use, and substance use disorders.
Objective
Psychiatric disorders (PDs) in patients with non-small cell lung cancer (NSCLC) may contribute to variation in stage at presentation and clinical outcomes. We hypothesized that PDs are independently associated with earlier stage at diagnosis but worse perioperative morbidity and reduced long-term survival.
Methods
Adults undergoing elective resection of stage I-III NSCLC were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database (July 2018-June 2024) and linked to Centers for Medicare & Medicaid Services (CMS) data to ascertain long-term survival. PDs included depressive, anxiety, psychotic, alcohol use, and substance use disorders. Primary outcomes were stage at diagnosis, extent of resection, perioperative morbidity, and 5-year survival. Covariates included sociodemographics, comorbidities, and operative approach. Multivariable logistic regressions estimated associations between PDs on each of the binary outcomes and reported as adjusted odds ratios (aOR). Risk-adjusted survival was derived using multivariable Cox proportional hazards regression with effect size reported as adjusted hazard ratios (aHR).
Results
Among 103,263 patients, 24.4% (n=25,163) had ≥1 PD. The incidence of PDs increased from 16.8% in 2018 to 28.0% in 2024 (p<0.001). Patients with PDs tended to be younger (median 67 vs. 69 years; p<0.001) and to be current smokers (28.9% [7,282/25,163] vs. 20.6% [16,076/78,100]; p<0.001). Comorbidities and PFTs were similar. In risk-adjusted analysis, patients with a PD were more likely to have clinical stage I disease (aOR 1.12, 95% CI:1.08-1.18). No significant differences were observed in the use of sublobar resection (aOR 1.02, 95% CI:0.99-1.06). Perioperative mortality, morbidity, and length of stay were all significantly increased in patients with PDs (Table). Linkage to CMS identified 36,724 patients (59% of eligible patients ≥65 years). PD prevalence and clinical characteristics in the linked cohort mirrored the full population. In risk-adjusted analysis, 5-year mortality was significantly greater among patients with PDs (aHR 1.12, 95% CI:1.05-1.18).
Conclusions
PDs among patients undergoing resection of NSCLC has nearly doubled in the past 6 years and are present in one in four patients. PDs are strongly associated with worse perioperative and long-term outcomes. These findings identify a growing problem and the need for targeted perioperative pathways and longitudinal support.
Brooks Udelsman (1), Jeremy Rosenbaum (2), Levi Bonnell (3), Niharika Parsons (4), Li Ding (5), Eric Kawaguchi (6), Matthew Kirkpatrick (6), Mark Block (7), Christopher Towe (8), Elizabeth David (9), Robert Habib (10), (1) Keck School of Medicine, USC, LOS ANGELES, CA, (2) Keck School of Medicine of USC, Los Angeles, CA, (3) Society of Thoracic Surgeons Research and Analytic Center, Chicago, IL, (4) The Society of Thoracic Surgeons Research and Analytic Center, Chicago, IL, (5) Keck Medicine of USC, Los Angeles, CA, (6) Keck School of Medicine of USC, LOS ANGELES, CA, (7) N/A, Hollywood, FL, (8) University Hospitals of Cleveland, Shaker Heights, OH, (9) University of Colorado Anschutz Medical Center, Aurora, CO, (10) Society of Thoracic Surgeons, Chicago, IL
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