Outcomes after pulmonary resection for malignancy in patients with severe and persistent mental illness

Individuals with severe and persistent mental illnesses (SPMI) have high rates of tobacco smoking compared to the general population, increasing their risk of thoracic malignancies. There is little literature focused on thoracic surgical outcomes in this vulnerable patient population. A retrospective cohort study of patients with SPMI and lung cancer was conducted with propensity-matching to non-SPMI patients. The Nova Scotia Cancer Registry was crosslinked with the Mental Health Encounter Database to identify patients with a diagnosis of lung cancer between 2013 and 2018 and a SPMI diagnosis. Administrative databases were used to extract demographics, procedure, adverse events, length of stay (LOS), discharge to higher level of care, pathologic stage, and survival. SPMI patients were propensity-matched to non-SPMI patients using age, sex, oncologic stage, and procedure type (open versus video assisted thoracic surgery (VATS)). Postoperative and oncologic outcomes were compared between the SPMI and non-SMPI groups. Eight SPMI patients were paired with 80 non-SPMI patients who underwent lung cancer resection. There were no statistically significant differences in LOS, readmissions or one-year survival. However, patients with SPMI had statistically significant lower 2-year survival and a trend towards a higher incidence of major postoperative adverse events. Curative intent lung resection can be tolerated in SPMI patients, however they may have a higher incidence of major postoperative adverse events. Patients with SPMI have similar one-year survival as non-SPMI patients undergoing lung cancer resection, but 2-year survival is worse. Studies including larger multi-center cohorts of patients are needed to further understand risks and outcomes of lung resection in SPMI patients.