Effects of Affective Disorders on Inpatient Narcotic Consumption and Hospital Outcomes Following Open Posterior Spinal Fusion for Adult Spine Deformity

Introduction: Affective disorders (ADs) can have a profound impact on surgical recovery. However, there are few studies investigating the impact of ADs on inpatient narcotic consumption. The aim of this study was to assess the impact of ADs on inpatient narcotic consumption and healthcare resource utilization in patients undergoing spinal fusion for adult spinal deformity (ASD).

Methods: A retrospective cohort study was performed using the Premier Healthcare Database (2016-2017). All adult patients who underwent surgery for ASD, identified using ICD-10 CM coding, were grouped by comorbidity diagnosis of an AD. Demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), LOS, cost, and non-routine discharge rates were assessed. Increased inpatient opioid use was categorized by MME (morphine milligram equivalents) consumption >75th percentile for the cohort. Multivariate analyses were performed to determine predictors of increased LOS, cost, and non-routine discharge.

Results: Of the 1,831 study patients, 674 (36.8%) had an AD. A smaller proportion of patients in the AD cohort were 65+ years of age (No AD: 59.3% vs AD: 51.5%, p=0.001) while a larger proportion of patients in the AD cohort identified as non-Hispanic White (No AD: 81.2% vs AD: 89.2%, p< 0.001). A greater proportion of patients in the AD cohort had Increased MME consumption (No AD: 21.1% vs AD: 31.5%, p< 0.001). The AD cohort also had a longer mean LOS (No AD: 6.82±4.36 days vs AD: 7.66±4.97 days, p< 0.001). Similarly, a greater proportion of patients in the AD cohort had non-routine discharges (No AD: 67.9% vs AD: 73.9%, p=0.039) and unplanned 30-day readmissions (No AD: 7.9% vs AD: 10.7%, p=0.041). On multivariate analysis, having an AD was significantly associated with increased cost [OR: 1.61, p< 0.001] and non-routine discharge [OR: 1.36, p=0.035].

Conclusion : Our study shows that affective disorders may be associated with increased inpatient opioid consumption and healthcare resource utilization.