Preoperative Patient-Reported Mental Health is Associated with High-Grade Complications after Radical Cystectomy

PURPOSE - Psychological distress has been associated with 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 (RC).

METHODS - We retrospectively identified patients who underwent RC for bladder cancer (BC) who completed Short Form 12 (SF-12) surveys for self-assessment of their health status less than 6 months prior to surgery. Median physical (PCS) and mental (MCS) composite scores were calculated. An expert model including known predictors of postoperative high-grade complications was developed, and SF-12 PCS and MCS were added to determine their association with this endpoint.

RESULTS - From January 2010 - August 2014, 472 patients underwent RC for BC of which 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 PCS was 43.1 (interquartile range [IQR]: 33.0 - 51.5) and MCS was 48.5 (IQR: 39.5 - 54.7) in responders. Forty-six (16.8%) responders experienced a high-grade 30-day complication. Patients with a high-grade complication had lower preoperative median SF-12 MCS (44.8 vs 49.8, p=0.004) but no difference in PCS (39.2 vs 43.8, p=0.06). SF-12 MCS 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 RC. Patient self-assessment of their health status before surgery through validated questionnaires, therefore, may provide additional information useful in predicting short-term postoperative outcomes.

J Urol. 2015 Jul 30. pii: S0022-5347(15)04503-6. doi: 10.1016/j.juro.2015.07.095. [Epub ahead of print]

Sharma P1, Henriksen CH1, Zargar-Shoshtari K1, Xin R2, Poch MA1, Pow-Sang JM1, Sexton WJ1, Spiess PE1, Gilbert SM3.

1 Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL.
2 Department of Informational Services, Moffitt Cancer Center, Tampa, FL.
3 Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL; Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL