Introduction: Psychiatric diagnoses, including anxiety and depression, diagnosed after radical cystectomy (RC) for bladder cancer have been linked to increased risks of suicide, cancer-specific and all-cause mortality. However, the potential impact of psychiatric diagnoses on postoperative healthcare resource utilization are less well-understood. Herein, we sought to identify associations between psychiatric diagnoses and perioperative outcomes following RC within the state of Florida.
Methods: The Florida Hospital Inpatient Data File was queried to identify patients who underwent RC between 2013-2019. The exposure was defined as an ICD-10 code for a mood or anxiety disorder and analyzed as a 3-level variable: no mood or anxiety disorder, either a mood or anxiety disorder, and both a mood and anxiety disorder. Outcomes analyzed included inpatient mortality (death or discharge to hospice), non-home discharge, in-hospital complications, and length of stay. Mixed-effects logistic regression accounting for patients clustered within hospitals were used for categorical outcomes and negative binomial regression models were utilized for continuous outcomes.
Results: A total of 4396 RC patients were identified, of whom 306 (7.0%) had a mood disorder, and 389 (8.8%) had an anxiety disorder. After adjusting for age, sex, comorbidity, payer, patient region, surgical approach, and average facility volume, patients with either a mood or anxiety disorder (OR 1.49, 95% CI 1.12-1.98) and both a mood and anxiety disorder (OR 2.79, 95% CI 1.73-4.50) had significantly increased odds of discharge to a non-home facility. Additionally, either a mood or anxiety disorder (IRR 1.13, 95% CI 1.07-1.19) and both a mood and anxiety disorder (IRR 1.12, 95% CI 1.01-1.24) were significantly associated with increased length of stay. There were no significant associations between mood and/or anxiety disorders with inpatient mortality or the presence or number of postoperative complications.
Conclusions: In the state of Florida, patients with mood and/or anxiety disorders undergoing RC for bladder cancer had an increased length of stay and increased odds of discharge to a non-home facility, but no difference in the risk of perioperative complications. Differences in behavioral or socioeconomic factors may underlie the observed differences in outcome. These data may be helpful to guide perioperative resource planning in caring for RC patients with psychiatric diagnoses.