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Annals of Surgical Oncology

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Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients

Ira L. Leeds MD, MBA, ScM, Patrick M. Meyers BA, Zachary O. Enumah MD, Jin He MD, PhD, FACS, Richard A. Burkhart MD, FACS, Elliott R. Haut MD, PhD, FACS, Jonathan E. Efron MD, FACS, Fabian M. Johnston MD, MHS, FACS
Health Services Research and Global Oncology
Volume 26, Issue 4 / April , 2019



The specific effect of psychosocial risk factors on surgical outcomes in cancer patients remains unexplored. The purpose of this prospective observational study was to assess the association of preoperative psychosocial risk factors and 30-day complications following cancer surgery.


Psychosocial risks among elective gastrointestinal cancer surgery patients were ascertained through structured interviews using well-established screening forms. We then collected postoperative course by chart review. Multivariable analysis of short-term surgical outcomes was performed in those with a low versus high number of psychosocial risks.


Overall, 142 patients had a median age of 65 years (interquartile range 55–71), 55.9% were male, and 23.1% were non-White. More than half (58.2%) of the study population underwent a resection for a hepato-pancreato-biliary primary tumor, and 31.9% had a colorectal primary tumor. High-risk biomedical comorbidities were present in 43.5% of patients, and three-quarters of patients (73.4%) had at least one psychosocial risk. Complication rates in patients with at least one psychosocial risk were 28.0 absolute percentage points higher than those with no psychosocial risks (54.4% vs. 26.2%, p = 0.039). Multiple psychosocial risk factors in medically comorbid patients independently conferred an increase in the odds of a complication by 3.37-fold (95% CI 1.08–10.48, p = 0.036) compared with those who had one or no psychosocial risks.


We demonstrated a more than threefold odds of a complication in medically comorbid patients with multiple psychosocial risks. These findings support the use of psychosocial risks in preoperative assessment and consideration for inclusion in preoperative optimization efforts.

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