60. Spine patients demystified: what are the predictive factors of poor surgical outcomes in patients after elective lumbar spine surgery?

Abstract

BACKGROUND CONTEXT Pre-existing comorbid mood disorders are a known risk factor for impaired health-related quality of life and poor long term outcomes after spine surgery. 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 lumbar spine surgery. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 256 consecutive patients who underwent elective lumbar spine surgery at a single academic institution from 2014-2016 with 2-year follow up data. OUTCOME MEASURES Perioperative variables, opioid consumption, postoperative complications, visual analog scale (VAS) pain score, Oswesty Disability Index (ODI) score. METHODS Patient preoperative diagnosis of psychiatric mood disorder (depression, anxiety, schizophrenia, bipolar, or dementia), baseline characteristics, medical comorbidities, operative variables, and surgical complications (superficial and deep infection, wound complication, ED visits, re-admissions, and repeat operations) were recorded. Additionally, preoperative ED visits, pre- and postoperative opioid requirements, total opioid prescription quantities and most recent date of opioid prescription were collected. Quantitative measurements of pain (VAS) and disease specific disability score (ODI) were recorded preoperatively and 3 months after surgery. Continuous variables were compared between those with or without diagnosed mood disorders using two-tailed independent t-test, and categorical variables were compared using chi-square or Fisher Exact tests as appropriate. RESULTS Of the 256 patients included in this study, 113 (44.7%) had a preoperative diagnosis of comorbid psychiatric mood disorder. Patients with psychiatric comorbidity were more commonly females (p=0.04), smokers (p=0.003), alcohol dependent (p=0.01) and illicit drug abusers (p=0.03). Also, they had a significant higher presence of diabetes (p=0.02), HTN (p=0.01), COPD (p=0.02), chronic pain syndrome (p=0.001), and worse preoperative ASA classification (p=0.02) compared to patients without mood disorders. There were no statistical differences regarding preoperative ED visits, surgical complications, prior opioid or postoperative opioid consumption between groups. However, while not significant, patients with psychiatric comorbidity tended to have a higher rate of wound complications (p=0.06). Patients with mood disorders had significantly higher VAS values both prior to and 3 months following surgery (p=0.01), but there was no difference in ODI score between groups. CONCLUSIONS Patients with psychiatric comorbidities undergoing elective lumbar spine surgery had significantly more comorbidities and risk factors for a poor surgical outcome. These patients should be counseled that they will experience significantly higher pain during the perioperative and postoperative period compared to patients without mood disorders. A preoperative diagnosis of a comorbid mood disorder may be a predictor of higher rate of wound complications; however, this difference did not demonstrate statistical significance and should not discourage patients with a clinical diagnosis of mood disorder from undergoing lumbar spine surgery. Because of the prevalence of both comorbid psychiatric conditions and medical comorbidities, treatment algorithms are necessary to medically optimize patients prior to surgery to reduce the risk of complication or a poor postoperative outcome. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.