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.
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Article info
Publication history
Published online: May 31, 2019
Accepted:
April 20,
2019
Footnotes
Patrick M. Meyers, Ira L. Leeds, Zachary O. Enumah, Elliott R. Haut, and Fabian M. Johnston are responsible for the study design. Patrick M. Meyers, Ira L. Leeds, Zachary O. Enumah, and Fabian M. Johnston are responsible for data acquisition and analysis. Patrick M. Meyers, Ira L. Leeds, and Fabian M. Johnston are responsible for interpretation of the data and drafting work. Critical revision was performed by Zachary O. Enumah, Richard A. Burkhart, Jin He, Elliott R. Haut, and Jonathan E. Efron. Patrick M. Meyers, Ira L. Leeds, Zachary O. Enumah, Richard A. Burkhart, Jin He, Elliott R. Haut, Jonathan E. Efron, and Fabian M. Johnston gave final approval and accountability for the manuscript.
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© 2019 Elsevier Inc. All rights reserved.
