Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833, Taiwan.
Int J Environ Res Public Health. 2021 May 18;18(10):5391. doi: 10.3390/ijerph18105391.
The relationship between preexisting major psychiatric disorders and outcomes of spine surgery for degenerative thoracic/lumbar disease remains unclear. A 5% subset of inpatients was randomly selected from the Taiwan National Health Insurance Research Database. A total of 10,109 inpatients aged 18 years or over with degenerative thoracic/lumbar disease and underwent spine surgery met inclusion criteria. Major psychiatric disorders diagnosed by psychiatrists preceding index surgery, including anxiety disorder, depression disorder, bipolar disorder, schizophrenia and dementia, were identified. The prevalence of psychiatric disorders, and their differential risks on in-hospital and post-discharge outcomes were examined. 10.4% had major psychiatric disorders, of which depression (6.6%) and anxiety (4.9%) were most common. Logistic regression revealed increased risks of ventilator use in depression (OR = 1.62, 95% CI = 1.04-2.54, < 0.05), extended hospitalization length in bipolar (OR = 1.77, 95% CI = 1.08-2.89, < 0.05), and higher rehabilitation utilization in depression (OR = 1.25, 95% CI = 1.06-1.47, < 0.01) and bipolar (OR = 1.69, 95% CI = 1.04-2.76, < 0.05). Those patients with anxiety had a decreased risk of longer hospitalization duration (OR = 0.77, 95% CI = 0.60-0.98, < 0.05), while those with dementia and schizophrenia had no change in risks. Preoperative recognition of major psychiatric disorders for risk and treatment assessment is suggested as people with preexisting depression or bipolar disorder have worse outcomes after spine surgery.
先前存在的主要精神障碍与退行性胸/腰椎疾病脊柱手术结果之间的关系尚不清楚。从台湾全民健康保险研究数据库中随机选择了 5%的住院患者作为亚组。共纳入 10109 名年龄在 18 岁及以上、患有退行性胸/腰椎疾病并接受脊柱手术的住院患者，符合纳入标准。在索引手术前，由精神科医生诊断出主要精神障碍，包括焦虑障碍、抑郁障碍、双相情感障碍、精神分裂症和痴呆症。检查了精神障碍的患病率及其对住院和出院后结果的差异风险。有 10.4%的患者患有主要精神障碍，其中抑郁（6.6%）和焦虑（4.9%）最为常见。Logistic 回归显示，抑郁患者使用呼吸机的风险增加（OR=1.62，95%CI=1.04-2.54， < 0.05），双相情感障碍患者住院时间延长（OR=1.77，95%CI=1.08-2.89， < 0.05），抑郁患者康复利用率较高（OR=1.25，95%CI=1.06-1.47， < 0.01）和双相情感障碍（OR=1.69，95%CI=1.04-2.76， < 0.05）。焦虑患者的住院时间较长的风险降低（OR=0.77，95%CI=0.60-0.98， < 0.05），而痴呆和精神分裂症患者的风险没有变化。建议在脊柱手术后，对术前存在的主要精神障碍进行风险和治疗评估，因为患有先前存在的抑郁症或双相情感障碍的患者的预后较差。
