Oral Posters: Values and Outcomes in Spine Surgery

Presented by: J. Moon - View Audio/Video Presentation (Members Only)


B. Diebo(1), C. Jalai(2), G. Poorman(2), S. Horn(2), J. Moon(2), Q. Naziri(1), T. Errico(2), A. Patel(1), V. Lafage(3), C. Paulino(1), P. Passias(2)

(1) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(2) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(3) Hospital for Special Surgery, Spine Service, New York, NY, United States


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: This is 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] with idiopathic, degenerative scoliosis diagnoses), total hip arthroplasty (THA) and total knee arthroplasty (TKA). In addition, 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, Personality and mental. Overall and specific incidences of PB were compared within MSK diagnoses, and between MSK and chronic conditions.

Results: 5,263,447 discharges identified, with mean age of 65.5 y/o and 55% of females. Distribution of diagnoses were: SPINE = 590,906 (CERV = 286,940, DEGEN = 272,742, ASD = 31,224), THA = 725,946, TKA = 1,019,795, HEART = 1,595,835 DM = 1,053,243, and LUNG = 277,722. On average, 27.8% of MSK patients had an in-hospital psychological impairment. The PB of MSK increased from 15.5% to 35.3% from 2001-2012. Prevalence of PB among diagnoses groups is reported in Figure 1. In details, MSK had the highest frequency of patients with sleep disorders (MSK = 4.4%, DM = 2.8%, LUNG = 1.9%, HEART = 3.8%), second highest with depression (MSK = 10.3%, DM = 10.9%, LUNG = 7.2%, HEART = 6.9%) and anxiety (MSK = 4.5%, DM = 3.0%, LUNG = 5.2%, HEART = 3.4%) and third highest with substance abuse disorders (MSK = 10.4%, DM = 14.9%, LUNG = 23.2%, HEART = 9.2) (p< 0.001 all cases). In SPINE, revision patients displayed higher PB in comparison to primary cases (CERV = 41% vs. 33%, DEGEN = 41.5% vs. 36%, ASD = 42.3% vs. 36.5%), however, patients undergoing revision joint surgeries had less PB (THA: 21.2 vs. 27.3%), (TKA: 19.7% vs. 24.2%) (p< 0.001 all). MSK patients with PB were younger (61.3 vs. 64.8 years), and PB was higher in females (29.1 vs. 25.8%).

Conclusions: Prevalence of psychological impairments in patients undergoing surgery for certain musculoskeletal disorders is higher than admissions for diabetes, lung cancer, and heart diseases. The psychological impact of spine, hip, and knee pathologies may have an additive effect to the disability and socioeconomic burden caused by these diseases. Though these patients were found to be younger, data revealed associated increased length of stay and total hospital charges. Proper psychological screening, patient counseling, and appropriate psychological support is recommended as a compliment to treatment for musculoskeletal diseases.