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Examining the relationship between severe persistent mental illness and surgical outcomes in women undergoing mastectomy for breast cancer

Published:December 27, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.12.019

      Highlights

      • Severe persistent mental illness portends worse outcomes in breast cancer patients.
      • SPMI is associated with longer hospitalization after mastectomy.
      • SPMI is associated with more bilateral mastectomies and less breast reconstruction.
      • SPMI increases the risk of post-procedural infection and sepsis.
      • There is increased need for standardized screening to identify patients with SPMI.

      Abstract

      Background

      Severe persistent mental illness (SPMI) is associated with worse outcomes in cancer patients. Less is known about the relationship between SPMI and surgical outcomes after mastectomy for breast cancer.

      Methods

      We selected patients with breast cancer and SPMI from the National Inpatient Sample (2016–2018) and used propensity score matching. We then used multivariate analysis, Kruskal-Wallis tests, and conditional logistic regression to compare demographics and outcomes.

      Results

      The study sample consisted of 670 patients: 536 without SPMI and 134 with SPMI. SPMI was associated with bilateral mastectomy (bilateral: 53% vs. unilateral: 42.7%, p = 0.033) and decreased frequency of breast reconstruction (p < 0.001). SPMI was associated with more extended hospitalization (4 days vs. 2 days, p < 0.001) and increased risk of developing post-procedural infection and sepsis (OR 2.909).

      Conclusions

      SPMI is associated with bilateral mastectomy, more extended hospitalization, and increased risk for post-procedural infection and sepsis – suggesting the need for increased use of standardized screening tools to identify SPMI in patients and inform perioperative management correctly.

      Keywords

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