Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, 740 S Limestone, K403, Lexington, KY 40536-0284, USA.
Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, 740 S Limestone, K403, Lexington, KY 40536-0284, USA.
Spine J. 2020 Oct;20(10):1529-1534. doi: 10.1016/j.spinee.2020.05.550. Epub 2020 Jun 2.
Pre-existing comorbid psychiatric mood disorders are a known risk factor for impaired health-related quality of life and poor long-term outcomes after spine surgery.
The purpose of this study was to investigate the effect of preexisting mood disorders on (1) pre- and postoperative patient-reported outcomes, (2) complications, and (3) pre- and postoperative opioid consumption in patients undergoing elective cervical or lumbar spine surgery.
STUDY DESIGN/SETTING: Retrospective review at a single academic institution from 2014 to 2017.
Consecutive adult patients who underwent cervical or lumbar surgery.
Quantitative measurements of pain (visual analog scale [VAS]) and spinal region-specific disability scores (Neck Disability Index [NDI] and Oswestry Disability Index [ODI]).
This is a retrospective review of 435 consecutive patients (179 cervical, 256 lumbar) who underwent elective spine surgery at a single academic institution from 2014 to 2017. Patient preoperative diagnosis of psychiatric mood disorder (eg, depression, anxiety, schizophrenia, bipolar, or dementia), baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, and surgical complications (eg, superficial and deep infection, wound complication, emergency department [ED] visits, readmissions, and repeat operations) were recorded. Additionally, preoperative ED visits, pre- and postoperative opioid requirements, total opioid prescription quantities and most recent dateof opioid prescription were collected. VAS, NDI, and ODI scores were recorded preoperatively and at 2, 6, and 12 weeks after surgery. Continuous variables were compared between those with and without diagnosed psychiatric comorbidity using two-tailed independent t test, and categorical variables were compared using chi-square or Fisher's exact tests. Analyses of variance and analysis of covariance were used to compare patient-reported outcomes between groups. A multivariate approach was taken to account for contribution of potential covariates in significant findings. Multiple linear regressions were used to determine variables associated with the number of postoperative opioid prescriptions.
Of the cervical and lumbar cohorts, 78 (43.6%) and 113 (44.1%), respectively, had a preoperative diagnosis of comorbid psychiatric mood disorder. Cervical patients with mood disorders received a significantly higher total number of opioid prescriptions post-operatively (4.6±5.2 vs. 2.8±3.9; p=.002). Patients with mood disorders had worse NDI scores at all time points (p=.04), however there were no differences in VAS pain scores (p=.5). There were no statistical differences between patients with and without mood disorders regarding baseline characteristics, medical (nonpsychiatric) comorbidities, operative variables, surgical complications, preoperative ED visits or prior opioid use (p>.05). For lumbar patients, patients with mood disorders were more commonly females (p=.04), tobacco users (p=.003), alcohol dependent (p=.01) and illicit-drug abusers (p=.03). There were no differences regarding surgical complications or opioid consumption. Tobacco use (p<.001) was the sole contributor to postoperative VAS pain scores. Patients with mood disorders had significantly higher VAS values both before and 3 months following surgery (p=.01), but there was no difference in ODI scores.
Patients with preoperative psychiatric mood disorders undergoing elective cervical surgery had worse NDI scores and received more opioid prescriptions, despite similar VAS scores as those without mood disorders. Lumbar surgery patients with mood disorders were demographically different than those without mood disorders and had worse pain before and after surgery, though ODI scores were not different. Tobacco use was the sole contributor to postoperative VAS pain scores. This information can be useful in counseling patients with mood disorders before elective spinal surgery.
先前存在的合并精神科情绪障碍是影响脊柱手术后健康相关生活质量和长期预后的已知危险因素。
本研究旨在调查术前情绪障碍对（1）术前和术后患者报告的结果、（2）并发症和（3）接受择期颈椎或腰椎手术的患者术前和术后阿片类药物使用的影响。
研究设计/设置：在 2014 年至 2017 年期间在一家学术机构进行的回顾性研究。
连续接受颈椎或腰椎手术的成年患者。
疼痛的定量测量（视觉模拟量表[VAS]）和脊柱特定区域残疾评分（颈椎障碍指数[NDI]和 Oswestry 残疾指数[ODI]）。
这是对 2014 年至 2017 年期间在一家学术机构接受择期脊柱手术的 435 例连续患者（颈椎 179 例，腰椎 256 例）进行的回顾性研究。患者术前精神科情绪障碍（如抑郁、焦虑、精神分裂症、双相或痴呆）的诊断、基线特征、非精神科合并症、手术变量和手术并发症（如浅表和深部感染、伤口并发症、急诊就诊、再入院和重复手术）均有记录。此外，还收集了术前急诊就诊、术前和术后阿片类药物需求、总阿片类药物处方数量和最近一次阿片类药物处方日期。记录术前和术后 2、6 和 12 周的 VAS、NDI 和 ODI 评分。使用双尾独立 t 检验比较有和无诊断性精神合并症的患者之间的连续变量，使用卡方或 Fisher 精确检验比较分类变量。使用方差分析和协方差分析比较患者报告的结果。采用多元方法考虑潜在协变量在显著发现中的贡献。使用多元线性回归确定与术后阿片类药物处方数量相关的变量。
在颈椎和腰椎队列中，分别有 78 例（43.6%）和 113 例（44.1%）患者术前诊断为合并精神科情绪障碍。患有情绪障碍的颈椎患者术后接受的阿片类药物总处方数量明显更高（4.6±5.2 vs. 2.8±3.9；p=.002）。患有情绪障碍的患者在所有时间点的 NDI 评分都较差（p=.04），但 VAS 疼痛评分无差异（p=.5）。有和没有情绪障碍的患者在基线特征、非精神科（非精神科）合并症、手术变量、手术并发症、术前急诊就诊或先前阿片类药物使用方面没有统计学差异（p>.05）。对于腰椎患者，患有情绪障碍的患者更常见为女性（p=.04）、吸烟者（p=.003）、酒精依赖者（p=.01）和非法药物使用者（p=.03）。在手术并发症或阿片类药物使用方面没有差异。吸烟（p<.001）是术后 VAS 疼痛评分的唯一贡献者。患有情绪障碍的患者在手术前后的 VAS 值明显更高（p=.01），但 ODI 评分无差异。
接受择期颈椎手术的术前患有精神科情绪障碍的患者 NDI 评分更差，阿片类药物处方更多，尽管与无情绪障碍的患者相比 VAS 评分相似。患有情绪障碍的腰椎手术患者与无情绪障碍的患者在人口统计学上存在差异，且术后疼痛更严重，尽管 ODI 评分无差异。吸烟是术后 VAS 疼痛评分的唯一贡献者。这些信息可用于在择期脊柱手术前为患有情绪障碍的患者提供咨询。
