The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery With Minimum 2-Year Surveillance
The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery With Minimum 2-Year Surveillance
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DOI：
10.1097/brs.0000000000002651
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发表时间：
2018-11-01
期刊：
影响因子：
3
通讯作者：
Paulino, Carl B.
中科院分区：
文献类型：
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作者：
Diebo, Bassel G.;Lavian, Joshua D.;Paulino, Carl B.
研究设计。回顾analysis.Objective。目的了解共病性精神健康障碍（mhd）对颈神经根病（CR）或颈脊髓病（CM）患者颈椎融合术后长期预后的影响。背景资料摘要。CR和CM患者的亚群存在MHDs，其对手术并发症的影响尚不清楚。使用纽约州全州规划和研究合作系统对2009年至2013年诊断为CR或CM并接受宫颈手术且至少监测2年的患者进行回顾性分析。合并MHD的患者与未合并MHD的患者进行比较。单变量分析比较了MHD和非MHD队列的人口统计学、并发症、再入院和修订。多变量二元logistic回归模型确定了独立的预后预测因子（协变量：年龄、性别、Charlson/Deyo评分和手术方式）。共纳入20,342例患者（MHD: n = 4819; non -MHD: n = 15,523）。确定的MHDs：抑郁（57.8%）、焦虑（28.1%）、睡眠（25.2%）和压力（2.9%）。CR患者合并MHD的发生率高于CM患者（P = 0.015）。术后2年，所有MHD患者的并发症发生率（特别是：器械相关、感染）、任何适应症再入院率和翻修手术率均显著升高（均P < 0.05）；回归模型证实了这些发现，并显示联合手术入路是任何并发症的最强预测因子（CR，比值比[OR]: 3.945, P < 0.001； CM，比值比[OR]: 2.828, P < 0.001）， MHD是未来翻修的最强预测因子（CR, OR: 1.269, P = 0.001； CM, OR: 1.248, P = 0.008）。近25%因CR和CM入院的患者伴有MHD合并症，并且在颈椎手术后至少2年内出现任何并发症、再入院或翻修的比例更高。结果必须通过利用更大的国家数据库的回顾性研究和前瞻性队列研究来证实。建议患者咨询和心理筛查/支持，以补充手术治疗。
Study Design. Retrospective analysis.Objective. To improve understanding of the impact of comorbid mental health disorders (MHDs) on long-term outcomes following cervical spinal fusion in cervical radiculopathy (CR) or cervical myelopathy (CM) patients.Summary of Background Data. Subsets of patients with CR and CM have MHDs, and their impact on surgical complications is poorly understood.Methods. Patients admitted from 2009 to 2013 with CR or CM diagnoses who underwent cervical surgery with minimum 2-year surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. Patients with a comorbid MHD were compared against those without (no-MHD). Univariate analysis compared demographics, complications, readmissions, and revisions between MHD and no-MHD cohorts. Multivariate binary logistic regression models identified independent predictors of outcomes (covariates: age, sex, Charlson/Deyo score, and surgical approach).Results. A total of 20,342 patients (MHD: n = 4819; no-MHD: n = 15,523) were included. MHDs identified: depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (P = 0.015). Two years postoperatively, all patients with MHD had significantly higher rates of complications (specifically: device-related, infection), readmission for any indication, and revision surgery (all P < 0.05); regression modeling corroborated these findings and revealed combined surgical approach as the strongest predictor for any complication (CR, odds ratio [OR]: 3.945, P < 0.001; CM, OR: 2.828, P < 0.001) and MHD as the strongest predictor for future revision (CR, OR: 1.269, P = 0.001; CM, OR: 1.248, P = 0.008) in both CR and CM cohorts.Conclusion. Nearly 25% of patients admitted for CR and CM carried comorbid MHD and experienced greater rates of any complication, readmission, or revision, at minimum, 2 years after cervical spine surgery. Results must be confirmed with retrospective studies utilizing larger national databases and with prospective cohort studies. Patient counseling and psychological screening/support are recommended to complement surgical treatment.