Mental illnesses among patients undergoing elective anterior cervical discectomy and fusion: Analysis from the National Readmissions Database

Abstract

ObjectivePatients with a comorbid mental illness have been observed to have worse outcomes following surgery. However, little is known about the effects of mental disorders on patient outcomes following spinal surgery. In the current study, we sought to investigate the characteristics of patients with mental illness, particularly anxiety, major depressive disorder, concurrent anxiety and schizophrenia, and the impact of these comorbid conditions on outcomes of patients undergoing anterior cervical discectomy and fusion (ACDF) using a national administrative database. Patients and methodsThe National Readmissions Database (NRD) was queried for patients undergoing an ACDF between 2012 and September 30th, 2015. The presence of anxiety, major depressive disorder, concurrent anxiety and schizophrenia were captured using International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariable logistic regression was used to establish an association between a mental comorbidity and risk of 30- and 90- day readmission. ResultsA total of 139,877 patients undergoing elective ACDF between 2012–2015 were identified, of which 15,927 (11.39 %) had anxiety, 514 (0.38 %) had major depressive disorder, 248 (0.18 %) had concurrent anxiety and major depressive disorder, and 287 (0.21 %) had schizophrenia. Upon multivariable analysis of procedural related readmissions, adjusting for an array of patient and hospital related factors, patients with schizophrenia, compared to controls, had a significantly higher risk of 30-day readmission (OR 2.62, 95 %CI 1.42–4.84, p = 0.002); moreover, schizophrenia (OR = 1.92, 95 % CI 1.13–3.25, p = 0.016) anxiety (OR = 1.13, 95 %CI 1.02–1.26, p = 0.023) were also associated with significantly higher risk of 90-day readmission. ConclusionOur analysis indicates that mental illness comorbidities may be associated with increased rates of procedure related readmission and longer length of stay following elective ACDF.