Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, United States; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, United States; Mayo Clinic Graduate School of Biomedical Sciences, United States.
Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, United States; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, United States; Mayo Clinic Graduate School of Biomedical Sciences, United States.
Clin Neurol Neurosurg. 2020 Jun;193:105765. doi: 10.1016/j.clineuro.2020.105765. Epub 2020 Mar 2.
Patients with a comorbid mental illness have been observed to have worse outcomes following surgery. However, little is known about the effects of mental disorders on patient outcomes following spinal surgery. In the current study, we sought to investigate the characteristics of patients with mental illness, particularly anxiety, major depressive disorder, concurrent anxiety and schizophrenia, and the impact of these comorbid conditions on outcomes of patients undergoing anterior cervical discectomy and fusion (ACDF) using a national administrative database.
The National Readmissions Database (NRD) was queried for patients undergoing an ACDF between 2012 and September 30th, 2015. The presence of anxiety, major depressive disorder, concurrent anxiety and schizophrenia were captured using International Classification of Diseases, Ninth Revision (ICD-9) codes. Multivariable logistic regression was used to establish an association between a mental comorbidity and risk of 30- and 90- day readmission.
A total of 139,877 patients undergoing elective ACDF between 2012-2015 were identified, of which 15,927 (11.39 %) had anxiety, 514 (0.38 %) had major depressive disorder, 248 (0.18 %) had concurrent anxiety and major depressive disorder, and 287 (0.21 %) had schizophrenia. Upon multivariable analysis of procedural related readmissions, adjusting for an array of patient and hospital related factors, patients with schizophrenia, compared to controls, had a significantly higher risk of 30-day readmission (OR 2.62, 95 %CI 1.42-4.84, p = 0.002); moreover, schizophrenia (OR = 1.92, 95 % CI 1.13-3.25, p = 0.016) anxiety (OR = 1.13, 95 %CI 1.02-1.26, p = 0.023) were also associated with significantly higher risk of 90-day readmission.
Our analysis indicates that mental illness comorbidities may be associated with increased rates of procedure related readmission and longer length of stay following elective ACDF.
患有合并精神疾病的患者在接受手术后的预后较差。然而，对于精神障碍对脊柱手术后患者结局的影响知之甚少。在本研究中，我们试图使用国家行政数据库研究患有精神疾病（特别是焦虑症、重度抑郁症、焦虑和精神分裂症并存）的患者的特征，以及这些合并症对接受前路颈椎间盘切除术和融合术（ACDF）患者结局的影响。
检索国家再入院数据库（NRD），以确定 2012 年至 2015 年 9 月 30 日期间接受 ACDF 的患者。使用国际疾病分类，第九版（ICD-9）代码来捕获焦虑、重度抑郁症、焦虑和精神分裂症并存的存在。使用多变量逻辑回归来建立精神合并症与 30 天和 90 天再入院风险之间的关联。
确定了 2012-2015 年期间接受择期 ACDF 的 139877 例患者，其中 15927 例（11.39%）患有焦虑症，514 例（0.38%）患有重度抑郁症，248 例（0.18%）患有焦虑和重度抑郁症并存症，287 例（0.21%）患有精神分裂症。在对程序相关再入院进行多变量分析时，在调整了一系列患者和医院相关因素后，与对照组相比，患有精神分裂症的患者 30 天再入院的风险明显更高（比值比 2.62，95%置信区间 1.42-4.84，p=0.002）；此外，精神分裂症（比值比=1.92，95%置信区间 1.13-3.25，p=0.016）和焦虑症（比值比=1.13，95%置信区间 1.02-1.26，p=0.023）与 90 天再入院的风险显著增加也相关。
我们的分析表明，精神疾病合并症可能与择期 ACDF 后程序相关再入院率和住院时间延长有关。
