Beletsky Alexander, Liu Cherry, Alexander Evan, Hassanin Samir W, Vickery Kim, Loomba Munish, Winston Nutan, Chen Jeffrey, Gabriel Rodney A
Department of Anesthesiology, Riverside Community Hospital, HCA Healthcare, Riverside, CA, USA.
Department of Anesthesiology, Riverside Community Hospital, HCA Healthcare, Riverside, CA, USA.
Neuromodulation. 2023 Jul;26(5):1081-1088. doi: 10.1016/j.neurom.2022.12.010. Epub 2023 Jan 29.
Outcomes after spinal cord stimulator (SCS) placement are affected by psychologic comorbidities. It is part of routine practice to do psychologic assessments prior to SCS trials to assess for the presence of maladaptive behavioral patterns. However, few studies have sought to quantify the effect of psychiatric comorbidities on complications, reoperation, and readmission rates. The purpose of this study was to assess the association of psychiatric comorbidities with postprocedural outcomes after SCS implantation.
Inclusion criteria included SCS placement between 2015 and 2020 (percutaneous approach or an open laminectomy-based approach) using Healthcare Corporation of America National Database. Data on psychiatric comorbidities present at the time of SCS implantation surgery were collected. Outcomes of interest included complication rates (defined as lead migration, fracture, malfunction, battery failure, postoperative pain, infection, dural puncture, or neurological injury), reoperation rates (defined as either revision or explant [ie, removal]), and readmission rates within 30-day and 1-year time after SCS implantation. We measured the association between psychiatric comorbidities and outcomes using multivariable regression and reported odds ratio (OR) and respective 95% confidence intervals.
A total of 12,751 cases were included. The most common psychiatric comorbidities were major depressive disorder (16.1%) and anxiety disorder (13.4%). In unadjusted univariate analysis, patients with any psychiatric comorbidity had heightened rates of any complication (27.1% vs 19.4%), infection (5.9% vs 1.9%), lead displacement (2.2% vs 1.3%), surgical pain (2.1% vs 1.2%), explant (14.7% vs 8.8%), and readmission rates at one year (54.2% vs 33.8%) (all p < 0.001). In multivariable logistic regression, with each additional psychiatric comorbidity, a patient had increased odds of experiencing any complication (OR = 1.5, 95% CI = 1.36-1.57, p < 0.001), requiring a reoperation (OR = 1.5, 95% CI = 1.37-1.6, p < 0.001), and requiring readmission (OR = 1.7, 99% CI = 1.6-1.8, p < 0.001).
The presence of psychiatric comorbidities was found to be associated with postoperative complication rates, reoperation, and readmission rates after SCS placement. Furthermore, each consecutive increase in psychiatric comorbidity burden was associated with increased odds of complications, reoperation, and readmission. Future studies might consider examining the role of presurgical mental health screening (ie, patient selection, psychologic testing) and treatment in optimizing outcomes for patients with psychiatric comorbidities.
脊髓刺激器（SCS）植入后的结果会受到心理合并症的影响。在进行SCS试验前进行心理评估以评估不良行为模式的存在是常规操作的一部分。然而，很少有研究试图量化精神疾病合并症对并发症、再次手术和再入院率的影响。本研究的目的是评估精神疾病合并症与SCS植入术后的术后结果之间的关联。
纳入标准包括2015年至2020年间使用美国医疗保健公司国家数据库进行的SCS植入（经皮途径或基于开放椎板切除术的途径）。收集SCS植入手术时存在的精神疾病合并症数据。感兴趣的结果包括并发症发生率（定义为电极移位、骨折、故障、电池故障、术后疼痛、感染、硬膜穿刺或神经损伤）、再次手术率（定义为翻修或取出[即移除]）以及SCS植入后30天和1年内的再入院率。我们使用多变量回归测量精神疾病合并症与结果之间的关联，并报告比值比（OR）和各自的95%置信区间。
共纳入12751例病例。最常见的精神疾病合并症是重度抑郁症（16.1%）和焦虑症（13.4%）。在未经调整的单变量分析中，患有任何精神疾病合并症的患者发生任何并发症的发生率更高（27.1%对19.
