172. Preoperative diagnosis of psychiatric mood disorder is predictive of postoperative course in patients after elective cervical spine surgery

Abstract

BACKGROUND CONTEXT Numerous studies have described associations between preexisting comorbid psychiatric mood disorders and increased health risks, poor surgical outcomes, and increased health care utilization. PURPOSE The purpose of this study was to investigate the effect of preoperative mood disorders on (1) pre- and postoperative patient-reported outcomes, (2) complications, and (3) pre- and postoperative opioid consumption in patients undergoing elective cervical spine surgery. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 179 consecutive patients who underwent elective cervical spine surgery at a single academic institution from 2014-2016 with 2-year follow-up data. OUTCOME MEASURES Perioperative variables, opioid consumption, visual analog scale (VAS) pain score, Neck Disability Index (NDI), postoperative complications. METHODS Patient preoperative diagnosis of psychiatric mood disorder (eg, depression, anxiety, schizophrenia, bipolar, or dementia), baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, and surgical complications (eg, superficial and deep infection, wound complication, emergency department (ED) visits, re-admissions, and repeat operations) were recorded. Additionally, preoperative ED visits, pre- and postoperative opioid requirements, total opioid prescription quantities and last date of opioid prescription were collected. Quantitative measurements of pain VAS and disease specific disability score NDI were recorded preoperatively and 3 months after surgery. Continuous variables were compared between those with diagnosed mood disorder and those without psychiatric comorbidity using two-tailed independent t-test, and categorical variables were compared using chi-square or Fisher Exact tests. RESULTS Of the 179 patients involved in this study, 78 (43.5%) had a preoperative diagnosis of comorbid psychiatric mood disorder. Fibromyalgia and irritable bowel syndrome were more common in patients with mood disorders (p=0.01). Patients with mood disorders required a statistically significant higher total number of opioid prescriptions postoperatively (4.6±5.2 vs 2.8±3.9, p=0.002). Patients with psychiatric comorbidity had worse NDI scores at all time points (p=0.04); however, there were no differences in VAS pain scores at any time point between groups (p=0.5). There were no statistical differences between patients with and without mood disorders regarding baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, surgical complications, preoperative ED visits or prior opioid use (p>0.05). CONCLUSIONS Patients with preoperative psychiatric comorbidities undergoing elective cervical spine surgery should be counseled that they may experience a significantly worse functional score during the perioperative and early postoperative period compared to patients without mood disorders. A preoperative diagnosis of a comorbid psychiatric mood disorder may be a predictor of higher postoperative opioid consumption, therefore, further study is appropriate for optimization of postoperative opioid prescribing practices in these patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.