Serious mental illness prolongs hospital admission following lung cancer resection

Background: Serious mental illness (SMI) is associated with increased complications and worse outcomes in a variety of surgical diseases, however, SMI as a risk factor in thoracic surgery patients is incompletely understood. We aimed to investigate if comorbid SMI would impact mortality and morbidity following lung cancer resection.

Methods: We identified 615 patients from the Society of Thoracic Surgery (STS) database at the University of North Carolina - Chapel Hill (January 2013-June 2021) who underwent lung cancer resection for non-small cell lung cancer (NSCLC). Patients identified with comorbid SMI as defined in prior studies were identified and stratified into mood, anxiety, and psychosis disorders. We analyzed the risk-adjusted impact of SMI on composite morbidity and mortality and length of stay (LOS) using multivariable logistic regression and Poisson regression analysis, respectively.

Results: Patients with SMI were younger, more frequently female, and more likely to be a smoker. Among identified patients, 186 (37.1%) had comorbid SMI which were predominantly mood disorders (90.3%). Overall, 116 patients (23.2%) had the primary outcome of composite postoperative mortality or morbidity. Following multivariable risk adjustment, patients with and without SMI did not have significantly different morbidity and mortality [odds ratio (OR) =1.36; 95% confidence interval (CI): 0.86-2.15]. After adjusting for surgery performed and other covariates, LOS was significantly longer among patients with SMI [risk ratio (RR) =1.21; 95% CI: 1.13-1.30].

Conclusions: In a 7.5-year period from a single academic institution, patients undergoing lung cancer resection had high rates of SMI. While no difference in composite morbidity and mortality was demonstrated, patients with SMI had significantly longer LOS.