Serious mental illness prolongs hospital admission following lung cancer resection

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.

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.

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].

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.