In Response to The Increasing Burden of Depression in Patients Undergoing Head and Neck Cancer Operations
Year: 2024
Type: article
Abstract: We appreciate Feng and Yuan's insightful Letter to the Editor in response to “The Increasing Burden of Depression in Patients Undergoing Head and Neck Cancer Operations.”1 As astutely noted, major depressive disorder (MDD) in patients with head and neck cancer (HNCA) has become increasingly prevalent, requiring continued efforts to understand its implication on both short- and long-term outcomes. For the present study, both bivariate and propensity-matched analyses were employed to query the association of MDD with immediate in-hospital and readmission outcomes following HNCA operations. Although patients with depression did exhibit decreased in-hospital mortality on bivariate comparison, such a reduction was not observed in the propensity-matched cohort. This suggests that matching balanced the effect of possible confounders. Given the low incidence of mortality in our patient population (0.7%), this may also indicate lack of adequate power to detect a statistically significant difference in the propensity-matched cohort. Conversely, MDD remained linked to increased resource utilization as well as incidence of nonhome discharge and readmission after propensity matching, suggesting that this association is robust and independent of patient demographics, comorbidities, and operative characteristics accounted for in the study. In both bivariate and propensity-matched analyses, MDD was not associated with increased incidence of overall medical or surgical complication. As described in our Methodology, medical complication was derived from the sum of cardiac, infectious, neurologic, renal, respiratory, and thromboembolic events while surgical complication from that of postoperative shock, hemorrhage, hematoma, seroma, wound dehiscence, and fistula formation. On bivariate comparison, patients with MDD were found to have decreased cardiac events (1.0 vs. 1.9%, p < 0.001) and increased incidence of fistula formation (1.7 vs. 1.2%, p = 0.02). Such associations did not persist after propensity matching, with both groups having similar incidence of all complications assessed. While we agree with Feng and Yuan that assessing the impact of preoperative MDD on postoperative delirium is of great clinical significance, prior work within the Nationwide Readmissions Database (NRD) has demonstrated that delirium is often underestimated given the variability in its clinical presentation and assessment.2 This remains a limitation of the NRD, requiring further work to be done in a more granular dataset. We offer gratitude to Feng and Yuan for continuing the important discussion on the impact of MDD on our HNCA patients. As MDD becomes increasingly prevalent, continued efforts in assessing and its negative impact on patient outcomes and in developing appropriate interventions to mitigate such occurrences become imperative.
Source: The Laryngoscope
DOI: 10.1002/lary.31964
Institution: University of California, Los Angeles
Language: English
Topic: Head and Neck Cancer Studies
Subfield: Otorhinolaryngology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405951167