Relationship Between Affective Disorders and Healthcare Resource Utilization following Surgery for Cervical Spondylotic Myelopathy: A National Database Study

Introduction: Affective disorders (ADs) are common and can profoundly impact health. However, few studies have assessed the impact of comorbid ADs on postoperative outcomes following ACDF or PCDF for cervical spondylotic myelopathy (CSM). The aim of this study was to assess the association between preoperative ADs and hospital length of stay (LOS), non-routine discharge (NRD) disposition, and costs of admission following ACDF or PCDF for CSM.

Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample database. Adult patients (≥18 years old) undergoing ACDF or PCDF for CSM, identified using ICD-10-CM coding, were stratified by presentation of comorbid ADs. Patient demographics, hospital characteristics, comorbidities, operative variables, adverse events (AEs), LOS, discharge disposition, and costs were assessed. Multivariate analyses were performed to identify associations between preoperative AD diagnoses and LOS, NRD disposition, and costs.

Results: Of the 49,950 patients, 34,195 (68.5%) underwent ACDF and 15,755 (31.5%) underwent PCDF. 9,485 ACDF patients (27.7%) and 4,085 PCDF patients (25.9%) had comorbid ADs,. Mean LOS was significantly greater in the AD cohorts for both procedures (ACDF: No AD: 2.47+/- 3.42 days vs AD: 2.76 +/- 3.32 days, p=0.002; PCDF: No AD: 4.46 +/- 5.81 days vs AD: 5.14 +/-5.65 days, p=0.003). Patients with ADs undergoing PCDF incurred greater mean costs (No AD: $26,079 +/- $21,652 vs AD: $28,275 +/- $18,147, p=0.004), and had a significantly greater proportion of NRDs (No AD: 32.0% vs AD: 39.2%, p=0.001). Within the ACDF cohort, mean admission costs (p=0.153) and discharge disposition (p=0.548) were similar. On multivariate analysis for ACDF, comorbid AD was significantly associated with extended LOS [aOR: 1.52, CI (1.28, 1.79), p< 0.001] and NRD [aOR: 1.21, CI (1.01, 1.46), p=0.043], but not increased costs [p=0.563]. On multivariate analysis for PCDF, comorbid AD was significantly associated with extended LOS [aOR: 1.32, CI (1.06, 1.64), p=0.012] and NRD [aOR: 1.54, CI (1.27, 1.88), p< 0.001], but not increased costs [p=0.347].

Conclusion : Our study suggests that preoperative ADs may be associated with increased LOS and NRD for patients undergoing ACDF or PCDF for CSM. Further studies assessing strategies to perioperatively manage patients with ADs may improve outcomes and resource utilization.