Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity

Abstract

Study Design. Retrospective analysis of a prospectively collected, national inpatient hospital database. Objective. We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes. Summary of Background Data. Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity–related self-image. Methods. The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications. Results. A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer. Conclusion. Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks. Level of Evidence: 2

Affective association with and preference for flexible brace colors in older adults with spinal deformities

“…Our study found that the ASD patients had a more positive affectivity toward a flexible brace with achromatic color as the respondents may consider the real‐life application of the brace. As a large number of ASD patients suffer from pain, disability and low self‐image, 8,10 they might want to hide the fact that they are wearing a brace and reduce the prominence of the brace itself. These colors can be easily camouflaged under other garments, or the color of the brace is close to that of the skin.…”

“…In addition, braces usually result in less‐than‐ideal treatment compliance due to their appearance or discomfort. The negative emotions or feelings of the users and the visual aesthetics of braces may both negatively affect treatment outcomes or deteriorate both physical and mental health 9,10 . If the spinal conditions are not properly addressed, continual deterioration could result in the need for spinal surgery, which burdens healthcare systems and increases the need for the care management of ASD patients.…”

Preoperative Optimization for Adult Spinal Deformity Surgery

“…Cognitive impairment can cause postoperative complications in ASD patients, namely postoperative delirium, increased LOS, and difficulties with disposition 75–77 . There is no current evidence supporting cognitive training therapies in ASD patients undergoing deformity correction surgeries, and thus needs to be investigated further.…”

“…Cognitive impairment can cause postoperative complications in ASD patients, namely postoperative delirium, increased LOS, and difficulties with disposition. [75][76][77] There is no current evidence supporting cognitive training therapies in ASD patients undergoing deformity correction surgeries, and thus needs to be investigated further. However, evaluating for cognitive impairment can provide pertinent baseline information about the patient's risk for undergoing ASD surgery and aid in risk-benefit analysis of the various therapeutic options.…”

Effect of dementia on all-cause mortality in hip fracture surgery: a retrospective study on a nationwide Korean cohort

“…Moreover, it is difficult to manage patients with dementia before surgery, after surgery and during rehabilitation owing to the presence of behavioural and psychological disturbances 13. Therefore, the incidence of postoperative complications and risk of mortality are relatively high 14 15…”