E127: Disparities in Outcomes and Costs for Patients Undergoing Gastrectomy for Gastric Cancer with Mental Health Diagnoses

Mental health (MH) impacts cancer outcomes and surgical recovery. We aimed to understand the impact of psychiatric comorbidities on post-operative outcomes and cost of care for patients undergoing gastrectomy for gastric cancer (GC).

Methods:

Patients treated with gastrectomy for GC were identified from the IBM MarketScan Database and stratified based on the presence of a MH diagnosis. Post-operative outcomes, including length of stay (LOS), readmissions, emergency room (ER) visits, surgical admission cost, and post-operative complications [venous thromboembolic event (VTE), surgical site infection (SSI), failure to thrive (FTT)] were analyzed. Cost of care at 30 and 90 days included initial surgical care plus readmissions and ER visits.

Results:

We identified 1502 patients with GC undergoing subtotal or total gastrectomy (TG); 56% (836) were male, 16% (247) had a MH diagnosis. The most common MH diagnoses were anxiety (n=168, 11%) and depression (n=88, 6%). Overall, 64% (967) underwent partial gastrectomy, median LOS was 9 days [5-18 interquartile range (IQR)] and the median cost of surgical admission was $43,600 (21,608-88,600 IQR). At 30-days, 2% (n=31) were readmitted, 3% (n=42) had ER visits and 8% had a complication of VTE (n=96, 6%), SSI (n=11, 1%) or FTT (n=24, 2%). At 90-days 5% (n=71) were readmitted, 8% (n=128) had ER visits and 8% (n=128) had a complication, including 6% with VTE (n=97). Median 30- and 90-day cost of care was $44,047 (22,197-89,164 IQR) and $44,996 (11,684-90,854 IQR), respectively. Those with a MH diagnosis were younger (median age 59 years vs. 63, p< 0.001) and more likely than those without to have TG (45% vs. 34%, p=0.001), longer LOS (11 vs. 9 days, p= 0.001), and higher 30-day (13% vs. 7%, p=0.007) and 90-day (13% vs. 8%, p=0.009) complication rates. Readmissions and ER visits were similar between the two cohorts, p >0.05. Patients with a MH diagnosis had higher median surgical ($51,028 vs. $41,807, p=0.004), 30-day ($56,182 vs. $42598, p=0.003) and 90-day ($57,290 vs. $43,392, p=0.001) costs. Multivariate regression controlling for rurality, birth year, type of gastrectomy and sex found that a MH diagnosis was an independent predictor for greater LOS, 30-day, and 90-day complications, Figure 1.  Linear regression controlling for the same factors found that MH was an independent predictor for greater surgical, 30-day and 90-day costs.

Conclusions:

Patients with a mental health diagnosis at the time of gastrectomy for GC have greater LOS, 30 and 90-day complication rates, and cost of care. Interventions to mitigate these disparities are warranted.