788 Impact of Preoperative Mental Health State on Perioperative Surgical Outcomes After Lumbar Spine Fusions: An Analysis of the National Inpatient Sample (2009-2020)

Abstract

INTRODUCTION: The intersection of mental health and patient reported outcomes after various neurosurgical procedures has been well published. Although there is paucity in the literature focused on the surgical outcomes of patients after spinal fusion and their relationship with the patient’s mental state before surgery. METHODS: The National Inpatient Sample (NIS) database was utilized, with a search identifying all patients who underwent a spinal fusion in all years between 2009-2020. Once patients were identified, diagnosis codes for major psychiatric disorders (depression, anxiety, bipolar disorder) were utilized to separate sample into a psychiatric disorder cohort, and a control sample. Univariate and multivariate linear/logistic regression models were utilized to analyze data. RESULTS: A total of 2,877,241 patients were identified from this database, of which 647,951 (22.5%) of patients had a preoperative diagnosis of at least one of the psychiatric disorders. Univariate analysis of patient demographics in the psychiatric disorder cohort demonstrated that these patients were more likely to be female (67.26% vs. 50.74%, P < .001), and younger (58.88 years vs. 59.11 years, P < .001) when compared to control cohort. Increased rates of respiratory (P < .001), urinary (P < .001), cardiac (P < .001) complications were seen in the psychiatric disorder cohort. On multivariate analysis patients had increased odds of fusion disorders (OR, 1.62; 95% CI, 1.55-1.70, P < .001), mechanical injuries (OR, 1.27; 95% CI, 1.20-1.35, P < .001), and postoperative hematomas (OR, 1.29; 95% CI, 1.26-1.33; P < .001). CONCLUSIONS: Preoperative diagnosis of various psychiatric conditions have notable effects on postoperative outcomes after spinal fusion and should be evaluated preoperatively.