Postoperative complications in adult spinal deformity patients with a mental illness undergoing reconstructive thoracic or thoracolumbar spine surgery

Publication date: Available online 5 October 2018

Source: The Spine Journal

Author(s): Ishan Shah, Christopher Wang, Nick Jain, Blake Formanek, Zorica Buser, Jeffrey Wang

Abstract

Background Context

: Previous studies have found an association between mental illness and poor outcomes in spine surgery, but little is known about the effects of depression and/or anxiety on the adult spinal deformity population. In addition, most relevant studies exclusively focused on the lumbar spine and had relatively small patient sizes.

Purpose

The aim of this study was to investigate whether adult spinal deformity patients with depression and/or anxiety have an increased risk of postoperative complications and reoperation following posterior thoracolumbar spinal surgery.

Study Design/Setting

Retrospective database study.

Methods

Adult patients (over 18 years of age) with a diagnosis of spinal deformity undergoing any reconstructive thoracic or thoracolumbar spinal procedure with a posterior approach between 2007 and 2015 Q2 were identified using Current Procedural Terminology (CPT) codes to query the Pearl Diver patient record database (Pearl Diver Technologies, West Conshohocken, PA, USA). The database includes records of approximately 18 million patients across the United States who have Humana insurance. Further selection of patients with depression and/or anxiety and their associated postoperative complications were identified using ICD-9 and ICD-10 diagnosis codes (International Classification of Diseases 9^th-10^th edition). The mental illness cohort was matched to a control group according to age, sex, and Charlson Comorbidity Index (CCI). Patient data was analyzed for reoperation rates and incidence of common post-operative complications.

Results

Multi-level posterolateral fusion was the most common included posterior thoracic reconstructive surgery. The mental illness cohort (n = 327) had significantly increased rates of infection (OR = 1.743, P = 0.022) and respiratory complications (OR = 1.492, P = 0.02) at the 90-day postoperative period. The rates of incision and drainage (OR = 1.379, P = 0.475) and pneumonia (OR = 1.22, P = 0.573) were increased in the mental illness cohort at the 90-day postoperative period, but not significantly. There were no significant differences in complication and reoperation rates at 1-year post-operatively.

Conclusions

Patients with spinal deformity and pre-existing depression and/or anxiety treated with a posterior thoracolumbar reconstructive spinal surgery had significantly elevated risk of postoperative infections and respiratory complications when compared with the control group.

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