Psychological Comorbidities are Associated with Increased Length of Stay and Non-Routine Discharge Disposition in Spinal Fracture Patients: A NIS Analysis

Introduction: Spinal fractures can carry a high degree of morbidity and mortality. Medical comorbidities in spinal fractures can affect care, but the relationship between psychiatric comorbidities and spinal fracture outcomes has not been completely characterized. Understanding these relationships may reveal insights into how to improve care for this population.

Methods: Patients with initial and subsequent encounters focusing on spinal fractures (using the appropriate Clinical Classification Software Refined codes) were selected from the National Inpatient Sample (NIS) 2018-2021, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Within this subset, patients with anxiety, depression, schizophrenia, and alcohol use disorder were identified. Logistic and linear regression analyses were used to identify if these psychiatric comorbidities were associated with outcomes such as mortality, total cost, disposition, and length of stay.

Results: An estimated weighted subpopulation of 427195 patients (unweighted population = 85439) with spinal fractures was selected. The yearly percentage of patients with psychiatric comorbidities remained relatively stable (mean = 29.08%), peaking at 30.47% in 2020. Logistic regressions showed that spinal fracture psychiatric comorbidities are not significantly associated with mortality during admission or total charges. Spinal fracture patients with psychiatric comorbidities are less likely to have a routine-disposition (OR = 0.89, 95% CI [0.85, 0.92], p < 0.001). Additionally, psychiatric comorbidities are significantly associated with increased length of stay (Linear Regression Coefficient = 0.57, 95% CI [0.46, 0.67], p < 0.001).

Conclusion : This preliminary study suggests that psychiatric comorbidities in spinal fracture patients may be associated with non-routine disposition and increased length of stay. Further research is needed to better characterize the clinical courses of spinal fracture patients with psychiatric comorbidities, as well as prevent potential adverse outcomes.