Introduction: Cervical myelopathy is a common disorder of the spine caused by numerous disease processes and is often treated surgically. The impact of psychiatric disorders on postoperative outcomes following surgical interventions for cervical myelopathy is not well understood.
Methods: This was a retrospective cohort analysis performed on the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database 2013-2014, which is the largest publicly available inpatient, all-payer database in the United States. The NIS was queried for hospitalizations with a diagnosis of cervical myelopathy based on ICD-9-CM code 721.1. The analysis included only those undergoing a surgical procedure. Various demographic and outcomes variables were compared between cases with psychiatric comorbidities versus those without using Chi-square and Student's t-test. Multivariate analysis was used to identify the impact of a psychiatric diagnosis for various outcomes.
Results: 24,142 hospitalizations met the inclusion criteria. Of these, 1,002 (4.2%) had a diagnosed psychiatric disorder. Hospitalizations with a psychiatric comorbidity tended to be younger (58.9 vs. 62.0, p<0.0001), more female (54.5% vs. 43.4%, p<0.0001), have more coded secondary diagnoses (14.4 vs. 9.9, p<0.0001), and have higher rates of a number of comorbidities. Multivariate regression models showed a psychiatric comorbidity to be a significant predictor of non-home discharge (Odds ratio [OR]=1.487, 95% Confidence interval [CI]=[1.232, 1.795], p<0.0001), but not for the instance of any complication (OR=1.072, CI=[0.871, 1.321], p=0.51), nor mortality (OR=1.414, CI=[0.731, 2.737], p=0.30). A psychiatric comorbidity was associated with an increased length of stay (+0.59 days, CI=[0.34, 0.85], p<0.0001), but not any difference in total hospital charges (+$766, CI=[-$2,470, +$4,002], p=0.64).
Conclusions: Patients with psychiatric comorbidities undergoing surgical treatment for cervical myelopathy have increased non-home discharge, a longer length of hospital stay, but no increased postoperative complications or mortality, nor any significant difference in total hospital charges.
Patient Care: Understanding the impact of psychiatric comorbidities on mortality, complications, and discharge disposition of patients undergoing surgical treatment for cervical myelopathy will allow for improved risk stratification. Identifying the needs of this vulnerable population will aid in postoperative planning and help deliver quality, cost-effective care.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the demographic differences between patients with and without psychiatric comorbidities undergoing surgical treatment for cervical myelopathy, and 2) Understand the association between psychiatric comorbidities and postoperative complications including mortality, non-home discharge, length of hospital stay, and total hospital charges.