Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Abstract

Study Design: Literature review. Objective: The aim of this literature review is to examine the effects of psychological disorders on postoperative complications, surgical outcomes, and long-term narcotic use. We also hope to detail the value of preoperative identification and treatment of these pathologies. Methods: A series of systematic reviews of the relevant literature examining the effects of psychological disorders and spine surgery was conducted using PubMed and Cochrane databases. Results: Combined, the database queries yielded 2275 articles for consideration. After applying screening criteria, 96 articles were selected for inclusion. Patients with underlying psychological disease have higher rates of delirium, readmission, longer hospital stays, and higher rates of nonroutine discharge following spine surgery. They also have higher rates of chronic postoperative narcotic use and may experience worse surgical outcomes. Because of these defined issues, researchers have developed multiple screening tools to help identify patients with psychological disorders preoperatively for potential treatment. Treatment of these disorders prior to surgery may significantly improve surgical outcomes. Conclusion: Patients with psychological disorders represent a unique population with respect to their higher rates of spinal pain complaints, postoperative complications, and worsened functional outcomes. However, proper identification and treatment of these conditions prior to surgery may significantly improve many outcome measures in this population. Future investigations in this field should attempt to develop and validate current strategies to identify and treat individuals with psychological disorders before surgery to further improve outcomes.

A national snapshot of the impact of clinical depression on post-surgical pain and adverse outcomes after anterior cervical discectomy and fusion for cervical myelopathy and radiculopathy: 10-year results from the US Nationwide Inpatient Sample

“…Depressive disorders are described in the Malhi and Mann seminar [2] as recurrent lifelong illness in which incident episodes fluctuate during each patient's lifetime, while recovery may lack stable progress increasing the challenges of detection, diagnosis and management. Patients with depressive disorders, whether or not they were previously diagnosed, constitute a special subgroup of those undergoing spinal surgeries, and may exhibit higher levels of back pain, postoperative complications and overall poorer functional outcomes; surgical outcomes are often improved, however, by identifying and treating these depressed patients prior to scheduling spinal surgery [26].…”

Prevalence and Outcomes of Major Psychiatric Disorders Preceding Index Surgery for Degenerative Thoracic/Lumbar Spine Disease

“…Besides, the studies lack information on how the psychiatric diseases were diagnosed or based by physicians or psychiatrists [ 20 ]. Moreover, the studies provide evidence mainly regarding depression and anxiety; therefore, leave gap between the association of other major psychiatric disorders (MPD), such as bipolar disorder and schizophrenia [ 21 ], with spinal surgery outcomes [ 22 , 23 ]. Because of the limitation of the study design, determining whether the negative effects are primarily due to preexisting major psychiatric disorders is difficult.…”

Quantifying the collective influence of social determinants of health using conditional and cluster modeling

“…SDoH are broadly defined as the conditions in which people are born, work, live and play and include areas such as economic stability, education, social and community context, and environment [9]. Because recovery from spine surgery can be upwards of 6 months and correspond to increased psychological distress and decreased activity [10][11][12][13], we believe that the importance of addressing SDoH in this population is heightened.…”