P81. Effect of psychiatric comorbidities on outcomes following anterior cervical discectomy and fusion

BACKGROUND CONTEXT The incidence and prevalence of psychiatric disorders is increasing both domestically and internationally. Numerous studies have linked psychiatric comorbidities to increased health risks, poor treatment outcomes and higher use of health care resources. PURPOSE To assess the relationship between psychiatric comorbidities and medication use with outcomes following anterior cervical discectomy and fusion. STUDY DESIGN/SETTING Retrospective chart review of all patients undergoing anterior cervical discectomy and fusion over the course of 8 months at a local community hospital. PATIENT SAMPLE A total of 79 patients underwent anterior cervical discectomy and fusion. The mean age was 55.7 years. OUTCOME MEASURES Length of stay, disposition. METHODS Seventy-nine patient charts were reviewed retrospectively over the course of 8 months at Monmouth Medical Center. The procedure as well as age were recorded. DSM-V psychiatric diagnoses were noted in the patients’ problem list or admission diagnoses. Psychiatric medications from the admission medical reconciliation were recorded. Lastly, disposition was noted (rehabilitation facility versus home) for each patient. RESULTS Of the 79 patients included in this study, 31 had a diagnosed DSM-V psychiatric disorder. Of the patients with psychiatric diagnoses, 15 had anxiety, 11 had depression, 1 had bipolar disorder, 1 had obsessive compulsive disorder, 4 with both anxiety and depression and 1 had diagnosed with anxiety and bipolar disorder. The average length of stay for all patients was 1.4 +/- 1.0 days. For those with depression, the average length of stay was 1.5 +/- 0.9 days. In patients with anxiety, the average length of stay was 1.6 +/- 1.5 days. Lastly in patients with bipolar disorder, the average length of stay was 3 +/- 0 days. When compared to patients without psychiatric diagnoses, the difference in length of stay was statisically significant only for patients with bipolar disorder (p = .000408). In addition, patients with psychiatric diagnoses had a higher rate of nonroutine disposition compared to those without psychiatric diagnoses (OR 15.9, p 0.0471). Lastly, the difference in length of stay in patients taking psychoactive medications (1.7 +/-1.4 days) versus those that did not (1.23 +/- 0.6 days) was statistically significant (p 0.021523). CONCLUSIONS Patients with bipolar disorder and those that take psychiatric medications may be at risk for increased length of stay following anterior cervical discectomy and fusion. Additionally, patients with psychiatric diagnoses are at a higher risk for discharge to a rehabilitation facility compared to home. Patients undergoing anterior cervical discectomy and fusion may benefit from presurgical screening for psychiatric comorbidities. This may lead to improved patient expectations regarding discharge and a better understanding of outcomes in this population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The incidence and prevalence of psychiatric disorders is increasing both domestically and internationally. Numerous studies have linked psychiatric comorbidities to increased health risks, poor treatment outcomes and higher use of health care resources. To assess the relationship between psychiatric comorbidities and medication use with outcomes following anterior cervical discectomy and fusion. Retrospective chart review of all patients undergoing anterior cervical discectomy and fusion over the course of 8 months at a local community hospital. A total of 79 patients underwent anterior cervical discectomy and fusion. The mean age was 55.7 years. Length of stay, disposition. Seventy-nine patient charts were reviewed retrospectively over the course of 8 months at Monmouth Medical Center. The procedure as well as age were recorded. DSM-V psychiatric diagnoses were noted in the patients’ problem list or admission diagnoses. Psychiatric medications from the admission medical reconciliation were recorded. Lastly, disposition was noted (rehabilitation facility versus home) for each patient. Of the 79 patients included in this study, 31 had a diagnosed DSM-V psychiatric disorder. Of the patients with psychiatric diagnoses, 15 had anxiety, 11 had depression, 1 had bipolar disorder, 1 had obsessive compulsive disorder, 4 with both anxiety and depression and 1 had diagnosed with anxiety and bipolar disorder. The average length of stay for all patients was 1.4 +/- 1.0 days. For those with depression, the average length of stay was 1.5 +/- 0.9 days. In patients with anxiety, the average length of stay was 1.6 +/- 1.5 days. Lastly in patients with bipolar disorder, the average length of stay was 3 +/- 0 days. When compared to patients without psychiatric diagnoses, the difference in length of stay was statisically significant only for patients with bipolar disorder (p = .000408). In addition, patients with psychiatric diagnoses had a higher rate of nonroutine disposition compared to those without psychiatric diagnoses (OR 15.9, p 0.0471). Lastly, the difference in length of stay in patients taking psychoactive medications (1.7 +/-1.4 days) versus those that did not (1.23 +/- 0.6 days) was statistically significant (p 0.021523). Patients with bipolar disorder and those that take psychiatric medications may be at risk for increased length of stay following anterior cervical discectomy and fusion. Additionally, patients with psychiatric diagnoses are at a higher risk for discharge to a rehabilitation facility compared to home. Patients undergoing anterior cervical discectomy and fusion may benefit from presurgical screening for psychiatric comorbidities. This may lead to improved patient expectations regarding discharge and a better understanding of outcomes in this population.