ASO Author Reflections: The Importance of Supporting the Mental Health of Patients Undergoing Elective Pancreatectomy
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: The Importance of Supporting the Mental Health of Patients Undergoing Elective Pancreatectomy George Molina, MD, MPH1,2 and Motaz Qadan, MD, PhD1 Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, MA; 2Department of Surgery, Brigham and Women’s Hospital, Boston, MA
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PAST During the past 20 years, there have been significant improvements in survival following pancreatic operations for cancer, which have been attributed to improvements in systemic therapy and provision of care in the perioperative period.1,2 As we strive to improve outcomes following pancreatic surgery, we must broaden and optimize the preoperative evaluation of patients. Although the evaluation of fitness for pancreatic surgery is comprehensive, it frequently incorporates evaluation of cardiovascular, cerebrovascular, and pulmonary risk but does not routinely include an evaluation of mental health. This is despite the fact that mental health is common in the United States, including among patients and particularly in the oncologic setting.3–5 PRESENT In this current study, we evaluated the readmission burden associated with a preoperative diagnosis of depression among patients who underwent an elective pancreatectomy.6 We used the Nationwide Readmission Database, which is a sample of all inpatient admissions and readmissions in the United States and allows for generation of national estimates.7 The power of the database relates to its ability to track admissions to nonindex hospitals, which is important in patients who receive specialized care in
Ó Society of Surgical Oncology 2020 First Received: 22 April 2020 M. Qadan, MD, PhD e-mail: [email protected]
regionalized facilities. We found that 10.2% of patients in this cohort had a preoperative diagnosis of depression. The burden of 30-day postoperative readmission following an elective pancreatectomy was significantly higher among patients with a diagnosis of depression (25.1% vs. 21.0%, P = 0.04). After adjusting for patient characteristics, a diagnosis of depression was significantly associated with higher odds (29%) of 30-day postoperative readmission [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.01–1.65, P = 0.039]. FUTURE Preparing patients for complex surgical procedures, such as an elective pancreatectomy, should include evaluation and optimization of perioperative mental health, given the potential readmission burden. A preoperative diagnosis of depression should prompt an assessment of whether a patient’s depression is well-controlled, provide a review of pharmacologic therapy, and include a perioperative plan for administration and resumption of medications. This should ideally be done by the physician managing the depression (e.g., psychiatrist, psychologist, or primary care provider) who knows the patient well. If the depression has not been managed previously, or suspected to be new, a new referral should be made. Evaluation also should occur at the commencement of neoadjuvant th
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