TY - JOUR
T1 - Effect of Psychiatric Comorbidities on In-Hospital Outcomes and Cost for Cervical Spondylotic Myelopathy
AU - Rothrock, Robert J.
AU - Morra, Rocco P.
AU - Deutsch, Brian C.
AU - Neifert, Sean N.
AU - Cho, Samuel K.
AU - Caridi, John M.
N1 - Funding Information:
Conflict of interest statement: Samuel K. Cho reports paid consulting for Zimmer-Biomet, Globus Spine, and Medtronic Spine, and holds unrelated grants from National Institutes of Health and Zimmer-Biomet. John M. Caridi reports paid consulting for Zimmer-Biomet. The remaining authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Objective: The present study examined the differences in outcomes of cervical spinal surgery for patients with and without a major psychiatric comorbidity using the Healthcare Cost and Utilization Project National Inpatient Sample database. Methods: Data were queried from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2013 to 2014 for hospitalizations with a major psychiatric comorbidity and a diagnosis of cervical spondylotic myelopathy treated by an appropriate surgical procedure. The included psychiatric comorbidities were schizophrenia, episodic mood disorders (bipolar I and II disorders), delusional disorders, and psychoses not otherwise specified. Univariate and multivariate regression analyses were performed to determine the differences in outcomes between patients with and without a major psychiatric comorbidity. Results: A total of 18,335 hospitalizations met the inclusion criteria, of which 648 (3.5%) included a major psychiatric comorbidity. Multivariate regression analysis demonstrated that psychiatric comorbidity was an independent predictor of non–home discharge (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.43–2.30; P < 0.0001) and a longer hospital stay (+0.52 day; 95% CI, 0.43–0.61; P < 0.0001) but was not an independent predictor of overall complications (OR, 0.79; 95% CI, 0.58–1.07; P = 0.13) or total hospital charges ($1992; 95% CI, −$917–$4902; P = 0.18). Conclusions: Psychiatric comorbidity was associated with an increased risk of non–home discharge and a longer length of stay for patients undergoing surgical intervention for cervical myelopathy. However, we did not find an associated increased risk of in-hospital mortality, complications, or total hospital charges. Psychiatric comorbidity should not be weighed against patients who require surgical treatment for cervical spondylotic myelopathy, and special attention should be given to postoperative care and discharge planning for this unique patient population.
AB - Objective: The present study examined the differences in outcomes of cervical spinal surgery for patients with and without a major psychiatric comorbidity using the Healthcare Cost and Utilization Project National Inpatient Sample database. Methods: Data were queried from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2013 to 2014 for hospitalizations with a major psychiatric comorbidity and a diagnosis of cervical spondylotic myelopathy treated by an appropriate surgical procedure. The included psychiatric comorbidities were schizophrenia, episodic mood disorders (bipolar I and II disorders), delusional disorders, and psychoses not otherwise specified. Univariate and multivariate regression analyses were performed to determine the differences in outcomes between patients with and without a major psychiatric comorbidity. Results: A total of 18,335 hospitalizations met the inclusion criteria, of which 648 (3.5%) included a major psychiatric comorbidity. Multivariate regression analysis demonstrated that psychiatric comorbidity was an independent predictor of non–home discharge (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.43–2.30; P < 0.0001) and a longer hospital stay (+0.52 day; 95% CI, 0.43–0.61; P < 0.0001) but was not an independent predictor of overall complications (OR, 0.79; 95% CI, 0.58–1.07; P = 0.13) or total hospital charges ($1992; 95% CI, −$917–$4902; P = 0.18). Conclusions: Psychiatric comorbidity was associated with an increased risk of non–home discharge and a longer length of stay for patients undergoing surgical intervention for cervical myelopathy. However, we did not find an associated increased risk of in-hospital mortality, complications, or total hospital charges. Psychiatric comorbidity should not be weighed against patients who require surgical treatment for cervical spondylotic myelopathy, and special attention should be given to postoperative care and discharge planning for this unique patient population.
KW - Cervical spondylotic myelopathy
KW - Degenerative cervical myelopathy
KW - Major psychiatric disorder
KW - Mental illness in spine surgery
KW - Outcomes of cervical myelopathy
UR - http://www.scopus.com/inward/record.url?scp=85068254184&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2019.05.258
DO - 10.1016/j.wneu.2019.05.258
M3 - Article
C2 - 31181363
AN - SCOPUS:85068254184
SN - 1878-8750
VL - 129
SP - e718-e725
JO - World Neurosurgery
JF - World Neurosurgery
ER -