Disparities in outcomes and costs of gastrectomy for gastric cancer among patients with depression and anxiety.

Background: Depression and anxiety impact cancer outcomes and surgical recovery. We evaluated the effect of these common psychiatric comorbidities on post-operative outcomes and cost of care for patients undergoing gastrectomy for gastric cancer (GC). Methods: Patients treated with gastrectomy for GC were identified from the IBM MarketScan Database and stratified based on the presence of depression and anxiety diagnoses. We analyzed postoperative outcomes including length of stay (LOS), readmissions, emergency department (ED) visits, and complication rates, as well as cost of care. Results: We identified 1502 patients with GC undergoing subtotal or total gastrectomy; 15% (n = 221) had a diagnosis of either anxiety (n = 168, 11%) and/or depression (n = 88, 6%). Multivariate regression controlling for rurality, age, gastrectomy type, and sex found the presence of one of these depression and/or anxiety diagnoses was an independent predictor for greater LOS (11 vs. 9 days, p < 0.001) and higher 30-day (13% vs. 8%, p = 0.019) complication rates. A diagnosis of depression or anxiety also independently predicted higher median costs for index surgical admission ($50,262 vs. $42,380, p = 0.01) as well as total 90-day costs ($56,983 vs. $43,707, p = 0.004). Conclusions: Patients with diagnoses of depression or anxiety at the time of gastrectomy for GC are at risk for longer LOS, higher complication rates, and increased cost of care. Interventions to mitigate these disparities are warranted.