- Email: [email protected]
P133. Impact of depression on short-term outcomes following anterior cervical discectomy and fusion
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231 adjusted for age, sex and CCIwas performed to calculate adjusted odds ratios (ORs), 95% confidence interval and significance level for each complication category, with the inpatient cohort treated as the exposed group. RESULTS: Throughout the time period, 1,469 and 1,192 patients received inpatient and outpatient single-level PCF, respectively. In both cohorts, the mean age was 65 to 69-year age group. The mean CCIs § SD of inpatient and outpatient groups were 2.83§3.11 and 1.46§2.21, respectively (P <0.001). Patients who received inpatient PCF showed significantly higher rates of wound complications (Odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.16 to 2.62; P=0.015), dysphagia (OR=2.36, CI=1.07 to 5.98; P=0.047), acute respiratory failure (OR=5.17, CI=2.46 to 12.70; P <0.001), sepsis (OR=4.90, CI=1.87 to 16.94; P=0.004), and urinary tract infections and incontinence (OR=1.96, CI = 1.30 to 3.01; P=0.002). CONCLUSIONS: Compared to inpatient single-level PCF, outpatient PCF is associated with a lower risk of perioperative surgical and medical complications, including wound complications, dysphagia, acute respiratory failure, sepsis, urinary tract infection and urinary incontinence. PCF in outpatients is a safe procedure for the treatment of cervical radiculopathy with an appropriate patient selection. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.556
P132. PROMIS depression and anxiety correlate with postoperative NASS satisfaction in cervical patients Rafa Rahman, BS1, Alvaro Ibaseta, MS2, Nicholas S. Andrade, BS2, Richard L. Skolasky, ScD3, Lee H. RileyIII, MD4, David B. Cohen, MD, MPH4, Daniel M. Sciubba, MD1, Khaled M. Kebaish, MD4, Brian J. Neuman, MD2; 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 Baltimore, MD, US; 3 Johns Hopkins University, Baltimore, MD, US; 4 Johns Hopkins Outpatient Ctr/Dept Ortho Surgery, Baltimore, MD, US BACKGROUND CONTEXT: Poor mental health is associated with lower satisfaction in surgery at large. Many cervical spine patients endorse psychiatric symptoms, but there is limited understanding of how these symptoms are related to postoperative satisfaction. The NASS satisfaction scale serves as a metric for satisfaction, with lower numbers indicating higher satisfaction. Mental health can be assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety (0 to 100 point scales with higher scores for severe symptoms) both preoperatively and postoperatively. PURPOSE: To determine whether preoperative and postoperative PROMIS Depression and Anxiety scores correlate with postoperative satisfaction. STUDY DESIGN/SETTING: Retrospective review at a single institution. PATIENT SAMPLE: A total of 60 cervical patients. OUTCOME MEASURES: NASS satisfaction score. METHODS: PROMIS Depression, PROMIS Anxiety, and NASS satisfaction scores were collected for surgical cervical patients preoperatively and at 3 months postoperatively. Correlation was assessed for each preoperative and postoperative mental health metric versus postoperative satisfaction. RESULTS: A total of 60 cervical patients (avg. age 63 years old) had mean satisfaction of 1.5 [1.2 to 1.7]. Each postoperative mental health metric moderately correlated with satisfaction (PROMIS depression r=0.3, PROMIS Anxiety r=0.3). Preoperative mental health did not correlate with postoperative satisfaction. CONCLUSIONS: Postoperative PROMIS depression and anxiety moderately correlate with postoperative NASS satisfaction in surgical cervical patients, with worse postoperative mental health correlated with worse satisfaction. Preoperative depression and anxiety do not correlate with postoperative satisfaction. Addressing mental health concerns for operative cervical patients, particularly in the postoperative period, may increase satisfaction.
S219
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.557
P133. Impact of depression on short-term outcomes following anterior cervical discectomy and fusion Alexander M. Lieber, BA1, Natalie N. Stump, BS1, Gregory J. Kirchner, MPH1, Yehuda E. Kerbel, MD2, Andre Jakoi, MD3, Venkat Kavuri, MD4, Amrit Khalsa, MD5; 1 Drexel University College of Medicine, Philadelphia, PA, US; 2 Drexel University College of Medicine, Department of Orthopaedics, Philadelphia, PA, US; 3 Drisko, Fee & Parkins, Kansas City, KS, US; 4 Philadelphia, PA, US; 5 Hahnemann/ Drexel Department of Orthopaedic Surgery, Philadelphia, PA, US BACKGROUND CONTEXT: The increased prevalence of depression in patients suffering chronic pain, including neck and back pain, is well documented. Previous research has reported that a preoperative diagnosis of depression is associated with increased rates of complications, revision surgery and opioid use after spinal surgery. PURPOSE: This study aims to compare rates of perioperative complications, hospital charges, and length of stay (LOS) following anterior cervical discectomy and fusion (ACDF) in patients with and without a preoperative diagnosis of depression. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: A total of 292,009 patients underwent elective ACDF, with 28,918 patients (9.9%) having a preoperative diagnosis of depression. The average age for the depression and non-depression groups were 53.54 and 53.30 years, respectively. Patients under the age of 18 years were excluded. OUTCOME MEASURES: This study compared perioperative complication rates, hospital costs and length of stay (LOS) following ACDF between the groups. METHODS: A total of 35 million hospital discharges between 2010 to 2014 were screened using the National Inpatient Sample (NIS). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients who underwent ACDF, as well as patients with a preoperative diagnosis of depression. Perioperative complications were identified using ICD-9-CM diagnosis codes. Logistic regression analyses were performed to compare complication rates between the two groups. The Kruskal Wallis H test was used to calculate and compare mean LOS and hospital charges. RESULTS: Complication rates were higher in patients without depression compared to patients with depression (3.09% vs 2.54%, p<0.001). Multivariate analysis also demonstrated a higher risk of perioperative complication for patients without depression (OR=1.179, 95% CI=1.081-1.285). The LOS was longer in the non-depression group compared to the depression group (2.31 § 4.83 days vs 2.10 § 3.02 days, p <0.001). There was no difference in hospital charges between the two groups. CONCLUSIONS: Patients with a preoperative diagnosis of depression had lower rates of perioperative complications and shorter LOS following ACDF compared to patients without a diagnosis of depression. While our findings contrast previous investigations of the role of depression in orthopedic surgery outcomes, our findings add to a small but growing body of literature reporting decreased rates of perioperative complications in patients with depression. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.558
P134. Preoperative PROMIS scores can predict patient satisfaction following surgery for cervical degeneration Alvaro Ibaseta, MS1, Rafa Rahman, BS2, Nicholas S. Andrade, BS1, Richard L. Skolasky, ScD3, Lee H. RileyIII, MD4, David B. Cohen, MD,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
P132. PROMIS depression and anxiety correlate with postoperative NASS satisfaction in cervical patients Rafa Rahman, BS1, Alvaro Ibaseta, MS2, Nicholas S. Andrade, BS2, Richard L. Skolasky, ScD3, Lee H. RileyIII, MD4, David B. Cohen, MD, MPH4, Daniel M. Sciubba, MD1, Khaled M. Kebaish, MD4, Brian J. Neuman, MD2; 1 Johns Hopkins University School of Medicine, Baltimore, MD, US; 2 Baltimore, MD, US; 3 Johns Hopkins University, Baltimore, MD, US; 4 Johns Hopkins Outpatient Ctr/Dept Ortho Surgery, Baltimore, MD, US BACKGROUND CONTEXT: Poor mental health is associated with lower satisfaction in surgery at large. Many cervical spine patients endorse psychiatric symptoms, but there is limited understanding of how these symptoms are related to postoperative satisfaction. The NASS satisfaction scale serves as a metric for satisfaction, with lower numbers indicating higher satisfaction. Mental health can be assessed with Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety (0 to 100 point scales with higher scores for severe symptoms) both preoperatively and postoperatively. PURPOSE: To determine whether preoperative and postoperative PROMIS Depression and Anxiety scores correlate with postoperative satisfaction. STUDY DESIGN/SETTING: Retrospective review at a single institution. PATIENT SAMPLE: A total of 60 cervical patients. OUTCOME MEASURES: NASS satisfaction score. METHODS: PROMIS Depression, PROMIS Anxiety, and NASS satisfaction scores were collected for surgical cervical patients preoperatively and at 3 months postoperatively. Correlation was assessed for each preoperative and postoperative mental health metric versus postoperative satisfaction. RESULTS: A total of 60 cervical patients (avg. age 63 years old) had mean satisfaction of 1.5 [1.2 to 1.7]. Each postoperative mental health metric moderately correlated with satisfaction (PROMIS depression r=0.3, PROMIS Anxiety r=0.3). Preoperative mental health did not correlate with postoperative satisfaction. CONCLUSIONS: Postoperative PROMIS depression and anxiety moderately correlate with postoperative NASS satisfaction in surgical cervical patients, with worse postoperative mental health correlated with worse satisfaction. Preoperative depression and anxiety do not correlate with postoperative satisfaction. Addressing mental health concerns for operative cervical patients, particularly in the postoperative period, may increase satisfaction.
S219
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.557
P133. Impact of depression on short-term outcomes following anterior cervical discectomy and fusion Alexander M. Lieber, BA1, Natalie N. Stump, BS1, Gregory J. Kirchner, MPH1, Yehuda E. Kerbel, MD2, Andre Jakoi, MD3, Venkat Kavuri, MD4, Amrit Khalsa, MD5; 1 Drexel University College of Medicine, Philadelphia, PA, US; 2 Drexel University College of Medicine, Department of Orthopaedics, Philadelphia, PA, US; 3 Drisko, Fee & Parkins, Kansas City, KS, US; 4 Philadelphia, PA, US; 5 Hahnemann/ Drexel Department of Orthopaedic Surgery, Philadelphia, PA, US BACKGROUND CONTEXT: The increased prevalence of depression in patients suffering chronic pain, including neck and back pain, is well documented. Previous research has reported that a preoperative diagnosis of depression is associated with increased rates of complications, revision surgery and opioid use after spinal surgery. PURPOSE: This study aims to compare rates of perioperative complications, hospital charges, and length of stay (LOS) following anterior cervical discectomy and fusion (ACDF) in patients with and without a preoperative diagnosis of depression. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: A total of 292,009 patients underwent elective ACDF, with 28,918 patients (9.9%) having a preoperative diagnosis of depression. The average age for the depression and non-depression groups were 53.54 and 53.30 years, respectively. Patients under the age of 18 years were excluded. OUTCOME MEASURES: This study compared perioperative complication rates, hospital costs and length of stay (LOS) following ACDF between the groups. METHODS: A total of 35 million hospital discharges between 2010 to 2014 were screened using the National Inpatient Sample (NIS). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes were used to identify patients who underwent ACDF, as well as patients with a preoperative diagnosis of depression. Perioperative complications were identified using ICD-9-CM diagnosis codes. Logistic regression analyses were performed to compare complication rates between the two groups. The Kruskal Wallis H test was used to calculate and compare mean LOS and hospital charges. RESULTS: Complication rates were higher in patients without depression compared to patients with depression (3.09% vs 2.54%, p<0.001). Multivariate analysis also demonstrated a higher risk of perioperative complication for patients without depression (OR=1.179, 95% CI=1.081-1.285). The LOS was longer in the non-depression group compared to the depression group (2.31 § 4.83 days vs 2.10 § 3.02 days, p <0.001). There was no difference in hospital charges between the two groups. CONCLUSIONS: Patients with a preoperative diagnosis of depression had lower rates of perioperative complications and shorter LOS following ACDF compared to patients without a diagnosis of depression. While our findings contrast previous investigations of the role of depression in orthopedic surgery outcomes, our findings add to a small but growing body of literature reporting decreased rates of perioperative complications in patients with depression. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.558
P134. Preoperative PROMIS scores can predict patient satisfaction following surgery for cervical degeneration Alvaro Ibaseta, MS1, Rafa Rahman, BS2, Nicholas S. Andrade, BS1, Richard L. Skolasky, ScD3, Lee H. RileyIII, MD4, David B. Cohen, MD,
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.