title: Psychiatric Illness is a Disparity in the Surgical Management of Rectal Cancer.
abstract: BACKGROUND
  Psychiatric disorders are common in the US and represent a major health disparity but little is known about their impact on surgical management and outcomes in cancer.
  
  
  OBJECTIVE
  The aim of this study was to determine whether rectal cancer patients with psychiatric diagnoses have fewer sphincter-preserving procedures and higher postoperative complications.
  
  
  METHODS
  Overall, 23,914 patients from the Nationwide Inpatient Sample (NIS) who underwent surgery for rectal cancer from 2004 to 2011 were identified. Patients with comorbid common psychiatric diagnoses were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes. Main outcomes were measured by operation performed, length of stay (LOS), postoperative complications, and discharge disposition.
  
  
  RESULTS
  Twenty percent of patients had a psychiatric diagnosis, with substance use being the most common psychiatric disorder (63 %). Patients with psychiatric diagnoses were more likely to be younger, White, have lower income, and have Medicaid insurance (p < 0.001) than those without. In a logistic regression model, patients with any psychiatric diagnosis were less likely to have sphincter-sparing surgery, controlling for patient sociodemographics, Charlson score, hospital procedure volume, and year (odds ratio 0.77; 95 % CI 0.72-0.83). LOS and postoperative complications were similar among the cohorts. Patients with psychiatric disorders were more likely to have home health care at discharge (p < 0.001).
  
  
  CONCLUSIONS
  Fewer sphincter-sparing procedures were performed on rectal cancer patients with psychiatric diagnoses. However, no significant differences in postoperative complications were observed.
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Wieghard
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Hart
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Herzig
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Kim C
authors.initials: KC
authors.lastname: Lu
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland, OR, USA. tsikitis@ohsu.edu.
authors.forename: V Liana
authors.initials: VL
authors.lastname: Tsikitis
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology / Q000601:surgery*; D008875:Middle Aged; D059351:Organ Sparing Treatments; D011183:Postoperative Complications; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000523:psychology / Q000601:surgery*