Patients with a depressive and/or anxiety disorder can achieve optimum Long term outcomes after surgery for grade 1 spondylolisthesis: Analysis from the quality outcomes database (QOD)
Introduction
According to a recent study, up to 8% of all patients undergoing a major spinal procedure may have a psychiatric disorder, most common among these being depression and anxiety. [1] The same study also found that the incidence of such disorders among patients undergoing spinal surgery has increased significantly in the past 2 decades [1].
Presence of psychiatric disorders has been shown to be associated with poor surgical outcomes among patients undergoing common major surgical procedures including, but not limited to general surgery procedures like cholecystectomy, appendectomy; [2] surgery for cancer of the gastrointestinal tract [2,3]; non-cardiac thoracic surgery [4]; and cardio-thoracic surgery [5]. For spine surgery, studies have analyzed the impact of mental illness on patients undergoing surgery for lumbar spinal stenosis and degenerative spondylolisthesis, cervical spine surgery and deformity surgery [1,[6], [7], [8]]. Such studies often query ICD or CPT-based administrative and insurance databases, and thus focus predominantly on outcomes such as length of stay, non-routine discharge, complications, readmissions and reoperations. Studies assessing the impact of mental illness on patient reported outcomes (PROs) and functional outcomes are scarce. Moreover, it is unclear whether such illnesses impact such outcomes in the short (3 months) or longer term (1 year or more).
In the current study, we analyzed data from a national spine registry to (i) characterize the differences in clinical factors between patients with a diagnosis of any depressive and/or anxiety disorder and (ii) to assess the impact of a diagnosis of an anxiety and/or depressive disorder, on short and longer term clinical as well as patient reported outcomes, among patients undergoing surgery for low-grade degenerative spondylolisthesis.
Section snippets
Cohort
For the current study, the Quality Outcomes Database (QOD) was queried for patients undergoing surgery for Meyerding grade 1 degenerative lumbar spondylolisthesis between July 1 st, 2014 and June 30th, 2016. The QOD is a prospective multi-institutional registry, which was established in 2012 with the goal to evaluate risk-adjusted expected morbidity, 30-day clinical outcomes of interest, 12-month and 24-month patient reported outcomes (PROs) and to establish a data-driven mechanism of providing
Results
Of the 608 patients, 156 patients (25.6 %) had any depressive and/or anxiety disorder at the time of enrollment into registry. Of these, 48 (13.15 %) had a depressive disorder alone, 33 (5.43 %) had an anxiety disorder alone, while 75 (12.3 %) had both a depressive and an anxiety disorder.
Discussion
As per recent estimates, up to 18.1 % of the population above the age of 18 (40 million adults) in the United States is living with anxiety, while 6.7 % of the population (16.1 million adults) have major depressive disorder. Moreover, these diagnoses often co-exist; almost half of the patients with depression also have anxiety. [23] Given the high incidence of these comorbidities in the general population, it has now become standard practice in most institutions to employ measures to identify
Limitations
Our study has some limitations. First, a diagnosis of a depressive or anxiety disorder was made using the electronic medical record at the time of enrollment into registry, thus we did not assess the severity or the exact DSM-V type of anxiety or depressive disorder at the time of surgery. Thus, the distinction between active depression or active anxiety and a history of anxiety or depression was not made and so some selection bias may have been introduced. Along the same lines, we did not
Conclusion
Using data from a national spine registry, we found that patients with an anxiety or a depressive disorder may achieve optimum long term functional outcomes after undergoing surgery for degenerative low grade spondylolisthesis. However, such patients may still be more likely to have a non-routine discharge and require reoperation within 2 years.
Credit authors statement
O.K. – Conceptualization and design, data collection, analysis, and drafting of manuscript
K.S.– Conceptualization and design, data collection, analysis, and drafting of manuscript
M.A.A.– Data collection, analysis, and drafting of manuscript
Y.U.Y. – Reviewing and revising original draft
K.F. – Reviewing and revising original draft
J.J.K. – Reviewing and revising original draft
A.C. – Reviewing and revising original draft
S.G. – Reviewing and revising original draft
J.R.S. – Reviewing and revising
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