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  • Psychological Burden of Musculoskeletal Diseases: Investigation on Spine, Hip and Knee In-Hospital Patients

    Final Number:

    Bassel G. Diebo MD; Cyrus M Jalai B.A.; Gregory W, Poorman; Qais Naziri MD; Samantha R. Horn; Thomas Errico; Ashish Patel MD; Virginie Lafage PhD; Carl Paulino MD; Peter G Passias MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    Introduction: Musculoskeletal disorders (MSK) are the leading cause of disability around the world. The psychological burden (PB) of these conditions experienced by patients and their families is of paramount importance. This study is investigation of the prevalence of psychological impairments in MSK in relation to other degenerative and chronic diseases.

    Methods: Retrospective review of the National Inpatient Sample (NIS) from 2001-2012. ICD-9 coding identified MSK patients undergoing surgical treatment for spinal (SPINE) pathologies (cervical fusions for radiculopathy, myelopathy, or deformity [CERV], 2-3 level fusions for lumbar degenerative disease [DEGEN], and adult spinal deformity [ASD]), total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients hospitalized for chronic conditions, including cardiac disease (HEART), diabetes (DM), lung cancer (LUNG) were identified. Based on ICD-9-CM codes reported in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), PB was defined as incidence of any of the following disorders: Depressive, Anxiety, Obsessive-compulsive, Stress, Somatic symptoms, Sexual dysfunction, Substance-related and addictive, Delirium, and Personality.

    Results: 5,263,447 discharges identified. On average, 27.8% of MSK patients had psychological impairment. In details, MSK had the highest frequency of patients with sleep disorders, second highest with depression and anxiety and third highest with substance abuse. In SPINE, revision patients displayed higher PB in comparison to primary cases, however, patients undergoing revision joint surgeries had less PB). MSK patients with PB were younger (61.3 vs. 64.8 years), and PB was higher in females.

    Conclusions: Prevalence of psychological impairments in patients undergoing surgery for certain musculoskeletal disorders is higher than admissions for diabetes, lung cancer, and heart diseases. Though these patients were found to be younger, data revealed associated increased length of stay and total hospital charges.

    Patient Care: This may aid surgeon's in identifying at-risk patients for poor outcomes due to psychological distress.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the importance of mental health evaluation in the context of various chronic conditions.


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