title: Preoperative Patient Reported Mental Health is Associated with High Grade Complications after Radical Cystectomy.
abstract: OBJECTIVE
  Psychological distress has been associated with an impaired immune response and poor wound healing. We hypothesized that preoperative patient reported mental health would be associated with high grade 30-day complications after radical cystectomy.
  
  
  METHODS
  We retrospectively identified patients who underwent radical cystectomy for bladder cancer who completed Short Form 12 (SF-12) surveys for self-assessment of health status less than 6 months before surgery. Median physical and mental composite scores were calculated. An expert model including known predictors of postoperative high grade complications was developed, and SF-12 physical composite score and mental composite score were added to determine their association with this end point.
  
  
  RESULTS
  From January 2010 to August 2014, 472 patients underwent radical cystectomy for bladder cancer, of whom 274 (58.1%) completed preoperative SF-12 questionnaires. Responders were more likely to be white (p=0.024), have higher preoperative albumin (p=0.037), receive neoadjuvant chemotherapy (p=0.002), have pT3/T4 disease (p=0.044) and have positive soft tissue surgical margins (p=0.006). Median SF-12 physical composite score was 43.1 (IQR 33.0-51.5) and mental composite score was 48.5 (IQR 39.5-54.7) in responders. Overall 46 (16.8%) responders experienced a high grade 30-day complication. Patients with a high grade complication had a lower preoperative median SF-12 mental composite score (44.8 vs 49.8, p=0.004) but no difference in physical composite score (39.2 vs 43.8, p=0.06). SF-12 mental composite score was also a significant predictive variable when added to our expert model (p=0.01).
  
  
  CONCLUSIONS
  Preoperative patient reported mental health was independently associated with high grade complications after radical cystectomy. Therefore, patient self-assessment of health status before surgery through validated questionnaires may provide additional information useful in predicting short-term postoperative outcomes.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Henriksen
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: Department of Informational Services, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Ren
authors.initials: R
authors.lastname: Xin
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Poch
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida; Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida. Electronic address: scott.gilbert@moffitt.org.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D001743:Urinary Bladder; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000601:surgery*
keywords: cystectomy; mental health; postoperative complications; urinary bladder neoplasms