The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery With Minimum 2-Year Surveillance.
Spine (Phila Pa 1976)
; 43(21): 1455-1462, 2018 Nov 01.
Article
en En
| MEDLINE
| ID: mdl-29579013
ABSTRACT
STUDY DESIGN:
Retrospective analysis.OBJECTIVE:
To improve understanding of the impact of comorbid mental health disorders (MHDs) on long-term outcomes following cervical spinal fusion in cervical radiculopathy (CR) or cervical myelopathy (CM) patients. SUMMARY OF BACKGROUND DATA Subsets of patients with CR and CM have MHDs, and their impact on surgical complications is poorly understood.METHODS:
Patients admitted from 2009 to 2013 with CR or CM diagnoses who underwent cervical surgery with minimum 2-year surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. Patients with a comorbid MHD were compared against those without (no-MHD). Univariate analysis compared demographics, complications, readmissions, and revisions between MHD and no-MHD cohorts. Multivariate binary logistic regression models identified independent predictors of outcomes (covariates age, sex, Charlson/Deyo score, and surgical approach).RESULTS:
A total of 20,342 patients (MHD nâ=â4819; no-MHD nâ=â15,523) were included. MHDs identified depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (Pâ=â0.015). Two years postoperatively, all patients with MHD had significantly higher rates of complications (specifically device-related, infection), readmission for any indication, and revision surgery (all Pâ<â0.05); regression modeling corroborated these findings and revealed combined surgical approach as the strongest predictor for any complication (CR, odds ratio [OR] 3.945, Pâ<â0.001; CM, OR 2.828, Pâ<â0.001) and MHD as the strongest predictor for future revision (CR, OR 1.269, Pâ=â0.001; CM, OR 1.248, Pâ=â0.008) in both CR and CM cohorts.CONCLUSION:
Nearly 25% of patients admitted for CR and CM carried comorbid MHD and experienced greater rates of any complication, readmission, or revision, at minimum, 2 years after cervical spine surgery. Results must be confirmed with retrospective studies utilizing larger national databases and with prospective cohort studies. Patient counseling and psychological screening/support are recommended to complement surgical treatment. LEVEL OF EVIDENCE 3.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Radiculopatía
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Enfermedades de la Médula Espinal
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Fusión Vertebral
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Vigilancia de la Población
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Trastornos Mentales
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Spine (Phila Pa 1976)
Año:
2018
Tipo del documento:
Article