Self-assessed mental health scores tied to radical cystectomy complications

Patients with bladder cancer and low scores on self-assessed mental health testing had more high-grade complications after radical cystectomy than their peers with better scores, even though their physical health was comparable, according to research published in the Journal of Urology.

The retrospective study mirrors past work linking preoperative mental disorders to adverse outcomes after major abdominal surgery, bariatric surgery, cardiac surgery, and kidney transplantation, said Dr. Pranav Sharma and his associates at Moffitt Cancer Center in Tampa. This study is the first to examine the association for bladder cancer patients who undergo radical cystectomy, according to the researchers.

They examined 30-day rates of Clavien grade IIIa or greater complications among 274 patients who filled out the Short Form 12 self-assessment of health status less than 6 months before surgery as part of a “new patient” questionnaire (J Urol. 2015. doi:10.1016/j.juro.2015.07.095). This included only 58% of radical cystectomy patients treated at Moffitt, and these patients had higher rates of positive soft-tissue margins and more aggressive pathology than did radical cystectomy patients who did not fill out the SF-12, the researchers said.

In all, 17% of patients experienced at least one high-grade complication within 30 days of their surgery. The median mental health composite score among patients with high-grade complications was 44.8 on a 100-point scale – significantly lower than the 49.8 score for patients who did not experience 30-day high-grade complications (P = .004). Physical composite scores did not significantly differ among patients who did and did not experience 30-day high-grade complications (median, 39.2 for patients with complications vs. 43.8 for those without; P = .06), the investigators said.

A model that incorporated known risk factors for postoperative complications – including age, body mass index, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, preoperative albumin, and pathologic tumor stage – was not significantly linked with 30-day high-grade complications, even after including the SF-12 physical composite score (P = .14), Dr. Sharma and his associates reported. The association, however, became significant after they added the mental health composite score to the model (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .01).

“Although there is responder subjectivity associated with survey-based health-related [quality of life] measures, this finding suggests that measuring baseline mental health before surgery may provide additional information that can improve the risk stratification of patients undergoing radical cystectomy,” they wrote.

The study might have lacked statistical power to detect some associations, and the small sample size precluded the researchers from testing associations between self-reported health and specific types of complications, they noted. Also, “since we evaluated patients retrospectively, only a non-causal association between preoperative SF-12 mental composite score and high-grade 30-day complications after radical cystectomy can be suggested,” they cautioned.

The research was partly supported by the Collaborative Data Services Core at the H. Lee Moffitt Cancer Center & Research Institute. The investigators declared no conflicts of interest.

Patients with bladder cancer and low scores on self-assessed mental health testing had more high-grade complications after radical cystectomy than their peers with better scores, even though their physical health was comparable, according to research published in the Journal of Urology.

The retrospective study mirrors past work linking preoperative mental disorders to adverse outcomes after major abdominal surgery, bariatric surgery, cardiac surgery, and kidney transplantation, said Dr. Pranav Sharma and his associates at Moffitt Cancer Center in Tampa. This study is the first to examine the association for bladder cancer patients who undergo radical cystectomy, according to the researchers.

They examined 30-day rates of Clavien grade IIIa or greater complications among 274 patients who filled out the Short Form 12 self-assessment of health status less than 6 months before surgery as part of a “new patient” questionnaire (J Urol. 2015. doi:10.1016/j.juro.2015.07.095). This included only 58% of radical cystectomy patients treated at Moffitt, and these patients had higher rates of positive soft-tissue margins and more aggressive pathology than did radical cystectomy patients who did not fill out the SF-12, the researchers said.

In all, 17% of patients experienced at least one high-grade complication within 30 days of their surgery. The median mental health composite score among patients with high-grade complications was 44.8 on a 100-point scale – significantly lower than the 49.8 score for patients who did not experience 30-day high-grade complications (P = .004). Physical composite scores did not significantly differ among patients who did and did not experience 30-day high-grade complications (median, 39.2 for patients with complications vs. 43.8 for those without; P = .06), the investigators said.

A model that incorporated known risk factors for postoperative complications – including age, body mass index, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, preoperative albumin, and pathologic tumor stage – was not significantly linked with 30-day high-grade complications, even after including the SF-12 physical composite score (P = .14), Dr. Sharma and his associates reported. The association, however, became significant after they added the mental health composite score to the model (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .01).

“Although there is responder subjectivity associated with survey-based health-related [quality of life] measures, this finding suggests that measuring baseline mental health before surgery may provide additional information that can improve the risk stratification of patients undergoing radical cystectomy,” they wrote.

The study might have lacked statistical power to detect some associations, and the small sample size precluded the researchers from testing associations between self-reported health and specific types of complications, they noted. Also, “since we evaluated patients retrospectively, only a non-causal association between preoperative SF-12 mental composite score and high-grade 30-day complications after radical cystectomy can be suggested,” they cautioned.

The research was partly supported by the Collaborative Data Services Core at the H. Lee Moffitt Cancer Center & Research Institute. The investigators declared no conflicts of interest.

Patients with bladder cancer and low scores on self-assessed mental health testing had more high-grade complications after radical cystectomy than their peers with better scores, even though their physical health was comparable, according to research published in the Journal of Urology.

The retrospective study mirrors past work linking preoperative mental disorders to adverse outcomes after major abdominal surgery, bariatric surgery, cardiac surgery, and kidney transplantation, said Dr. Pranav Sharma and his associates at Moffitt Cancer Center in Tampa. This study is the first to examine the association for bladder cancer patients who undergo radical cystectomy, according to the researchers.

They examined 30-day rates of Clavien grade IIIa or greater complications among 274 patients who filled out the Short Form 12 self-assessment of health status less than 6 months before surgery as part of a “new patient” questionnaire (J Urol. 2015. doi:10.1016/j.juro.2015.07.095). This included only 58% of radical cystectomy patients treated at Moffitt, and these patients had higher rates of positive soft-tissue margins and more aggressive pathology than did radical cystectomy patients who did not fill out the SF-12, the researchers said.

In all, 17% of patients experienced at least one high-grade complication within 30 days of their surgery. The median mental health composite score among patients with high-grade complications was 44.8 on a 100-point scale – significantly lower than the 49.8 score for patients who did not experience 30-day high-grade complications (P = .004). Physical composite scores did not significantly differ among patients who did and did not experience 30-day high-grade complications (median, 39.2 for patients with complications vs. 43.8 for those without; P = .06), the investigators said.

A model that incorporated known risk factors for postoperative complications – including age, body mass index, age-adjusted Charlson Comorbidity Index, American Society of Anesthesiologists score, preoperative albumin, and pathologic tumor stage – was not significantly linked with 30-day high-grade complications, even after including the SF-12 physical composite score (P = .14), Dr. Sharma and his associates reported. The association, however, became significant after they added the mental health composite score to the model (odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .01).

“Although there is responder subjectivity associated with survey-based health-related [quality of life] measures, this finding suggests that measuring baseline mental health before surgery may provide additional information that can improve the risk stratification of patients undergoing radical cystectomy,” they wrote.

The study might have lacked statistical power to detect some associations, and the small sample size precluded the researchers from testing associations between self-reported health and specific types of complications, they noted. Also, “since we evaluated patients retrospectively, only a non-causal association between preoperative SF-12 mental composite score and high-grade 30-day complications after radical cystectomy can be suggested,” they cautioned.

The research was partly supported by the Collaborative Data Services Core at the H. Lee Moffitt Cancer Center & Research Institute. The investigators declared no conflicts of interest.