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Association of Depression with In-Patient and Post-Discharge Disposition and Expenditures Among Medicare Beneficiaries Undergoing Resection for Cancer

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The impact of depression on utilization of post-discharge care and overall episode of care expenditures remains poorly defined. We sought to define the impact of depression on postoperative outcomes, including discharge disposition, as well as overall expenditures associated with the global episode of surgical care.

Method

The Medicare 100% Standard Analytic Files were used to identify patients undergoing resection for esophageal, colon, rectal, pancreatic, and liver cancer between 2013 and 2017. The impact of depression on inpatient outcomes, as well as home health care and skilled nursing facilities utilization and expenditures, was analyzed.

Results

Among 113,263 patients, 14,618 (12.9%) individuals had depression. Patients with depression were more likely to experience postoperative complications (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.31–1.42), extended length of stay (LOS) (OR 1.41, 95% CI 1.36–1.47), readmission within 90 days (OR 1.20, 95% CI 1.14–1.25), as well as 90-day mortality (OR 1.35, 95% CI 1.27–1.42) (all p < 0.05). In turn, the proportion of patients who achieved a textbook outcome following cancer surgery was lower among patients with depression (no depression: 53.3% vs. depression: 45.3%; OR 0.70, 95% CI 0.68–0.73). Patients with a preexisting diagnosis of depression had higher odds of additional post-discharge expenditures compared with individuals without a diagnosis of depression (OR 1.42; 95% CI 1.35–1.50); patients with a preexisting diagnosis of depression ($10,500, IQR $3,200–$22,500) had higher median post-discharge expenditures versus patients without depression ($6600, IQR $2100–$17,400) (p < 0.001). On multivariable analysis, after controlling for other factors, depression remained associated with a 19.0% (95% confidence interval [CI] 15.7–22.3%) increase in post-discharge expenditures.

Conclusions

Patients with depression undergoing resection for cancer had worse in-patient outcomes and were less likely to achieve a TO. Patients with depression were more likely to require post-discharge care and had higher post-discharge expenditures.

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Authors and Affiliations

  1. Department of Surgery, Wexner Medical Center and James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, USA

    Alessandro Paro MD, J. Madison Hyer MS & Timothy Pawlik MD, MPH, MTS, PhD, FACS, FRACS (Hon.)

  2. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University, Wexner Medical Center, Columbus, USA

    Timothy Pawlik MD, MPH, MTS, PhD, FACS, FRACS (Hon.)

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  1. Alessandro Paro MD
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  2. J. Madison Hyer MS
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Correspondence to Timothy Pawlik MD, MPH, MTS, PhD, FACS, FRACS (Hon.).

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Paro, A., Hyer, J.M. & Pawlik, T. Association of Depression with In-Patient and Post-Discharge Disposition and Expenditures Among Medicare Beneficiaries Undergoing Resection for Cancer. Ann Surg Oncol 28, 6525–6534 (2021). https://doi.org/10.1245/s10434-021-09838-7

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