71. Depression screening within 3 months of primary lumbar fusion decreases medical complications, emergency department visits, and costs of care In patients with diagnosed depressive disorder

BACKGROUND CONTEXT Studies have reported the detrimental effects of depression following spine surgery, however none have evaluated whether preoperative depression screening, in patients with a history of depression, is protective from adverse outcomes and lowers healthcare costs. PURPOSE The purpose of this study was to determine whether depression screenings/psychotherapy visits within 3 months prior to 1-2 level lumbar fusion (1-2LF) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations; 3) readmissions; and 4) healthcare costs. STUDY DESIGN/SETTING Retrospective cohort analysis of a large, nationwide administrative claims database of the United States population. PATIENT SAMPLE A retrospective query of all primary 1-2 level lumbar fusions for degenerative lumbar pathology was performed using a large private insurance claims database, PearlDiver, from January 1st, 2010, to October 31st, 2020. Cohorts of interest were queried using Current Procedural Terminology (CPT), International Classification of Disease, Ninth/Tenth (ICD-9), and ICD-10 procedural codes. OUTCOME MEASURES Primary outcomes of the study were to compare 90-day medical complications, 90-day Emergency department utilization, 90-day readmission rates, and 90-day costs of care. METHODS The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1-2LF. Two cohorts were 1:5 ratio matched and included those with (n=2,622) or without (n=13,058) a preoperative depression screen/psychotherapy visit within 3 months of LF. A 90-day surveillance period was utilized to compare outcomes. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.003 were significant. RESULTS DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs 16.00%; OR: 2.71, p<0.0001). Rates of ED utilization were increased in patients without screening vs screening (15.78% vs 4.23%; OR: 4.25, p<0.0001), despite no difference in readmissions (9.31% vs 9.53%; OR: 0.97, p=0.721). Finally, 90-day reimbursements ($51,160 vs $54,731) were significantly lower in the screened cohort (all p<0.0001). CONCLUSIONS Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, ED utilizations, and lower healthcare costs. Spine surgeons may use this data to counsel their patients with depression prior to surgical intervention. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Studies have reported the detrimental effects of depression following spine surgery, however none have evaluated whether preoperative depression screening, in patients with a history of depression, is protective from adverse outcomes and lowers healthcare costs. The purpose of this study was to determine whether depression screenings/psychotherapy visits within 3 months prior to 1-2 level lumbar fusion (1-2LF) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations; 3) readmissions; and 4) healthcare costs. Retrospective cohort analysis of a large, nationwide administrative claims database of the United States population. A retrospective query of all primary 1-2 level lumbar fusions for degenerative lumbar pathology was performed using a large private insurance claims database, PearlDiver, from January 1st, 2010, to October 31st, 2020. Cohorts of interest were queried using Current Procedural Terminology (CPT), International Classification of Disease, Ninth/Tenth (ICD-9), and ICD-10 procedural codes. Primary outcomes of the study were to compare 90-day medical complications, 90-day Emergency department utilization, 90-day readmission rates, and 90-day costs of care. The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1-2LF. Two cohorts were 1:5 ratio matched and included those with (n=2,622) or without (n=13,058) a preoperative depression screen/psychotherapy visit within 3 months of LF. A 90-day surveillance period was utilized to compare outcomes. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.003 were significant. DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs 16.00%; OR: 2.71, p<0.0001). Rates of ED utilization were increased in patients without screening vs screening (15.78% vs 4.23%; OR: 4.25, p<0.0001), despite no difference in readmissions (9.31% vs 9.53%; OR: 0.97, p=0.721). Finally, 90-day reimbursements ($51,160 vs $54,731) were significantly lower in the screened cohort (all p<0.0001). Patients who underwent a preoperative depression screening within 3 months of lumbar fusion had decreased medical complications, ED utilizations, and lower healthcare costs. Spine surgeons may use this data to counsel their patients with depression prior to surgical intervention.