Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery

Patrick M. Meyers, Ira L. Leeds, Zachary O. Enumah, Richard Burkhart, Jin He, Elliott Haut, Jonathan Efron, Fabian Johnston

Research output: Contribution to journalArticle

Abstract

Background: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. Methods: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. Results: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%–47%) for 5 risk factors and strong negative agreement (82%–99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112–0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. Conclusion: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.

Original languageEnglish (US)
JournalSurgery (United States)
DOIs
StatePublished - Jan 1 2019

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Psychology
Neoplasms
Documentation
Social Support

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery",
abstract = "Background: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. Methods: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. Results: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0{\%}–47{\%}) for 5 risk factors and strong negative agreement (82{\%}–99{\%}) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112–0.423). The overall complication rate was 36{\%}. The complication rate for patients with at least 1 clinically missed risk factor was 49{\%} vs 24{\%} in those without (P = .021), with a similar effect replicated for each individual risk factor. Conclusion: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.",
author = "Meyers, {Patrick M.} and Leeds, {Ira L.} and Enumah, {Zachary O.} and Richard Burkhart and Jin He and Elliott Haut and Jonathan Efron and Fabian Johnston",
year = "2019",
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journal = "Surgery",
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T1 - Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery

AU - Meyers, Patrick M.

AU - Leeds, Ira L.

AU - Enumah, Zachary O.

AU - Burkhart, Richard

AU - He, Jin

AU - Haut, Elliott

AU - Efron, Jonathan

AU - Johnston, Fabian

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. Methods: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. Results: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%–47%) for 5 risk factors and strong negative agreement (82%–99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112–0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. Conclusion: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.

AB - Background: Certain behavioral traits and inadequate social support are known risk factors for complications after cancer surgery. Despite their importance, it is unclear whether conventional patient preoperative evaluation captures them. This study was conducted to assess concordance between documentation and patient survey of selected risk factors and to determine whether failure to document affected postoperative outcomes. Methods: Adult patients at a tertiary academic medical center were surveyed before abdominal cancer surgery to assess 6 psychosocial risk factors. Risk factors were also assessed by retrospective chart review and compared with survey results through concordance measures. Thirty-day postoperative complications were abstracted by chart review. Rates of major complications for those with and without clinically missed risk factors were compared. Results: Comparisons between chart review and screening survey revealed poor-to-moderate positive agreement (0%–47%) for 5 risk factors and strong negative agreement (82%–99%) among all risk factors. Kappa analysis demonstrated poor-to-fair agreement among 5 risk factors (κ = 0.112–0.423). The overall complication rate was 36%. The complication rate for patients with at least 1 clinically missed risk factor was 49% vs 24% in those without (P = .021), with a similar effect replicated for each individual risk factor. Conclusion: This study shows a high level of discordance between formal screening and routine clinician documentation in a preoperative setting for psychosocial risk factors. There is a significant association between missing these risk factors and worse postoperative outcomes. Future work should examine whether structured screening of psychosocial risk factors may improve preoperative risk stratification through proactive interventions.

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