144. Common psychiatric conditions and anterior cervical discectomy and fusion: an assessment of postoperative outcomes, two-year costs, and postoperative opioid utilization
BACKGROUND CONTEXTDepression and anxiety are common psychiatric conditions among US adults, and anterior cervical discectomy and fusion (ACDF) remains one of the most commonly performed spinal surgeries. Mental health conditions are known to affect physical health and thus have the potential to contribute to adverse outcomes following spine surgery; however, a comprehensive assessment of long-term outcomes and the additive economic impact of these conditions in patients undergoing ACDF has not been well described.PURPOSETo investigate the association between both depression/anxiety and postoperative outcomes following ACDF.STUDY DESIGN/SETTINGRetrospective analysis of an administrative claims database.PATIENT SAMPLEA total of 16,149 patients who underwent ACDF between 2010-2014.OUTCOME MEASURESOur primary outcomes were 90-day readmission, >1 overnight hospital stay, 2-year revision surgery rate. Secondary outcomes included 2-year total costs of care, and chronic postoperative opioid use.METHODSUsing the Truven Health Marketscan private insurance claims database from 2010-2016, we identified patients who underwent ACDF with continuous enrollment six months prior and two years following the index surgery. Patients were excluded with posterior fusion, traumatic injury, cancer, schizophrenia or bipolar disorder. Chronic postoperative opioid use was defined as ≥ 120 days’ supply over the 3- to 12-month postindex visit period. Procedures and diagnoses were identified by Current Procedural Terminology (CPT) and International Classification of Diseases, version 9 (ICD-9) codes. Logistic and linear regressions were performed to evaluate the association between depression/anxiety and our primary and secondary outcomes, controlling for demographic variables and medical comorbidities.RESULTSA total of 16,149 patients met criteria for inclusion into the study. Mean age of patients was 50 ± 7.9 years, 56% females. 37% of females and 21% of males had a preoperative diagnosis of depression; 30% of females and 18% of males had a preoperative diagnosis of anxiety. After controlling for demographic and medical covariates, a preoperative diagnosis of depression was associated with increased probability of having >1 overnight hospital stay (OR 1.2, 95% CI 1.1 – 1.3), 90-day readmission (OR 1.6, 95% CI 1.4-1.9), having revision surgery within two years (OR 1.4, 95% CI 1.1-1.7), chronic postoperative opioid use (OR 1.6, 95% CI 1.5 – 1.7), and an increase of $5,965 in net 2-year health care costs (p<0.001). Patients with a diagnosis of anxiety also had increased probability of having >1 overnight hospital stay (OR 1.2, 95% CI 1.1 – 1.3), revision within two years (OR 1.3, 95% CI 1.2-1.6) chronic postoperative opioid use (OR 1.5, 95% CI 1.3 – 1.6) and an increase of $4,401 in 2-year costs (p<0.001), but did not have increased odds of 90-day readmission (OR 1.1, 95% CI 0.9 – 1.3).CONCLUSIONSPatients with diagnoses of depression or anxiety have increased probability of adverse outcomes and increased 2-year costs following ACDF. As these diagnoses are potentially modifiable, strategies to assess and optimize preoperative mental health prior to ACDF may improve outcomes and reduce costs.FDA DEVICE/DRUG STATUSThis abstract does not discuss or include any applicable devices or drugs.
۱۴۴. شرایط شایع روانپزشکی و دیسکتومی قدامی گردن و فیوژن: ارزیابی نتایج بعد از عمل، هزینههای دو ساله و استفاده از مخدر بعد از عمل
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