Association Between Baseline Affective Disorders and 30-Day Readmission Rates in Patients Undergoing Elective Spine Surgery

Adogwa, Owoicho; Elsamadicy, Aladine A.; Mehta, Ankit I.; Vasquez, Raul A.; Cheng, Joseph; Karikari, Isaac O.; Bagley, Carlos A.

doi:10.1016/j.wneu.2016.07.045

Cited by 34 publications

(28 citation statements)

References 18 publications

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“…The proportion that underwent laminectomy/laminotomy was 96.2% in the AA patients and 88.5% in the white patients (p = 0.09), with a similar number of median levels [IQR] treated (AA: 2 [2-3] vs white: 2 [2][3], p = 0.97). The proportion that underwent arthrodesis/fusion was similar in the two groups (AA: 26.4% vs white: 33.6%, p = 0.31), with similar median levels fused (1 [1-2] vs 1 [1][2], respectively, p = 0.80). The mean operative times for the AA and white cohorts were 110.9 ± 53.8 and 119 ± 62.1 minutes, respectively (p = 0.28).…”

Section: Intraoperative and Postoperative Variablesmentioning

confidence: 92%

“…5,12,14,25,26,29,33 Specifically in spine surgery, African American (AA) race has been associated with increased rates of postoperative complications, longer hospital stays, non-home discharges, 30day readmissions, and even death after surgery. 2,7,16,17,19,27 Moreover, other studies have associated racial disparities with surgical delay after diagnosis in symptomatic spine patients. 10 Therefore, to identify areas for improvement, a consideration of race-dependent outcomes of spine surgery is essential.…”

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confidence: 99%

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Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Elsamadicy

Kemeny

Adogwa

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

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Section: Intraoperative and Postoperative Variablesmentioning

confidence: 92%

mentioning

confidence: 99%

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Elsamadicy

Kemeny

Adogwa

et al. 2018

Journal of Neurosurgery: Spine

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“…Previous studies have described associations between preoperative depression and various outcomes of spinal surgery, including postoperative disability, patient satisfaction, and 30-day readmission rates. [1][2][3]23,29 Notably, the depressed population is particularly vulnerable to substance abuse and dependence issues, 7,17 but the link between depression and opioid use and abuse following lumbar fusion has remained largely unexplored. The only study reporting a link between depression and greater opioid use after lumbar fusion was performed in a workers' compensation setting, which has been associated with poorer overall outcomes than those of the general population, limiting the external validity and applicability of these findings.…”

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confidence: 99%

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

O’Connell

Azad²,

Mittal

et al. 2018

Neurosurgical Focus

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OBJECTIVEPreoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs.METHODSA retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug–use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs.RESULTSThe authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17–1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95–0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03–1.25), revision fusions (OR 1.15, 95% CI 1.05–1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04–1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84–1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p < 0.001) and 2 (β = 0.09, p < 0.001) years postoperatively.CONCLUSIONSAlthough these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.

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“…The included studies covered a range of surgical specialties: mixed specialties (585 930 patients in total), 17,20,22,28,29,31,40 and orthopaedic (5 383 241 patients), 18,21,23,27,32,37 colorectal or gastrointestinal (24 801 patients), 19,25,26,41 cardiothoracic or vascular (611 patients), [34][35][36][37][38] bariatric (21 405 patients), 30,33 breast (40 251 patients), 24,39 and plastic surgery (116 597 patients); 42 a total of 6 129 806 unique patients were included. Study sample sizes ranged between 21 34 and 5 339 284 patients.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Serious mental illness was diagnosed with an objective measure (eg, ICD diagnosis codes) or by a psychiatrist in 19 studies; in seven studies, it was determined with a validated patient self-report instrument. The investigated diagnoses were any serious mental illness, 17,19,[24][25][26]28,30,31,34,41,42 depression, 17,18,[20][21][22]25,32,33,[35][36][37]39,40 anxiety, 17,23,32,35,38,39,41 schizophrenia, 22,25,27,29,31,32 bipolar disorder, 17,22 and PTSD 17,22 (Supporting Information, table 2).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta‐analysis

McBride

Solomon

Bannon

et al. 2021

Medical Journal of Australia

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atients with serious mental illness who require surgical care are routinely treated in non-psychiatric hospitals. 1 As the prevalence of serious mental illness is relatively low (2-3% in Australia 2 ), it is unsurprising that surgeons only infrequently ask patients about their mental health before operations, and lack confidence in caring for these vulnerable and complex patients. 3 Serious mental illness should be treated like any other medical comorbidity and managed pro-actively, both before and after surgery, to optimise the patient's care. This ideal is realised for some surgery types, such as solid organ transplantation and bariatric surgery, 4,5 but established care pathways for patients undergoing routine surgical treatment are rare. Further, patients with serious mental illnesses have a higher burden of chronic disease, 6 experience negative attitudes from a range of health professionals, 7-11 and may find navigating complex health systems difficult. 12,13 Several studies have investigated surgical outcomes for people with serious mental illness, but there have been few reviews; findings with regard to relative mortality and morbidity have been mixed, and the overall risk for these vulnerable patients is unclear. The aim of our systematic review and meta-analysis was to develop a greater understanding of the association between having a serious mental illness and outcomes of elective surgery for adults, including in-hospital and 30-day mortality, hospital re-admission, post-operative complications, and hospital length of stay. MethodsWe employed the methods recommended by the Cochrane Methods Prognosis Group 14 and our review protocol concords with the PRISMA-P statement 15 (PROSPERO registration, CRD42018080114; 30 January 2018).

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Association Between Baseline Affective Disorders and 30-Day Readmission Rates in Patients Undergoing Elective Spine Surgery

Cited by 34 publications

References 18 publications

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

Surgical outcomes for people with serious mental illness are poorer than for other patients: a systematic review and meta‐analysis

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