Higher 2-Year Cumulative Incidence of Mental Health Disorders Following Irrigation and Debridement in Primary Lumbar Fusion

Matthew J Walker; Philip M Parel; Alisa Malyavko; Amy Zhao; Theodore Quan; Caillin Marquardt; Addisu Mesfin; Tushar C Patel

doi:10.22603/ssrr.2023-0138

Higher 2-Year Cumulative Incidence of Mental Health Disorders Following Irrigation and Debridement in Primary Lumbar Fusion

Spine Surg Relat Res. 2023 Oct 13;8(1):66-72. doi: 10.22603/ssrr.2023-0138. eCollection 2024 Jan 27.

Authors

Matthew J Walker¹, Philip M Parel¹, Alisa Malyavko¹, Amy Zhao¹, Theodore Quan¹, Caillin Marquardt¹, Addisu Mesfin², Tushar C Patel³

Affiliations

¹ Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
² Medstar Orthopaedic Institute, Georgetown University School of Medicine, Washington, DC, USA.
³ Washington Orthopaedics and Sports Medicine, Washington, DC, USA.

Abstract

Introduction: Spinal fusion is an operation that is employed to treat spinal diseases. Surgical site infection (SSI) after lumbar fusion (LF) is a postoperative complication. SSI is treated with irrigation and debridement (I&D), which requires readmittance following discharge or prolonged hospital stays, which are deleterious to patients' mental health. The long-term relationship between treating SSI with I&D and patients' mental health is still understudied.

Methods: Using the Mariner dataset from the PearlDiver Patient Records Database using Current Procedural Terminology and International Classification of Diseases procedure codes, retrospective cohort analysis was carried out. This study involved 445,480 patients who underwent LF with at least 2-year follow-up and were followed up for 2 years. Of the patients, 2,762 underwent I&D. Using univariate analysis employing Pearson Chi-square and Student t-test, where appropriate (Table 1), patient demographics between cohorts were gathered. 2-year cumulative incidence (CI) between LF and I&D cohorts was calculated using Kaplan-Meier analysis (Fig. 1, 2, 3). Cox proportional hazards were employed to observe significant differences in CI rates (Table 2).

Results: For patients who received I&D, 2-year CI depression (HR: 1.72; 95% CI: 1.49-1.99; P<0.001) and stress (HR: 1.35; 95% CI: 1.02-1.79; P=0.035) rates were significantly higher than for those who did not. There was no statistically significant difference in 2-year CI anxiety rates between cohorts (HR: 0.92; 95% CI: 0.58-1.46; P=0.719).

Conclusions: In conclusion, 16.8% of patients developed new-onset depression 2 years following I&D, in comparison to 10.3% of those who underwent LF. Patients who underwent I&D following LF were significantly more likely to experience depression and stress. To mitigate negative mental health outcomes, mental health services should be available to patients who underwent surgery.

Keywords: Lumbar fusion; irrigation and debridement; mental health; postoperative outcomes; surgical site infection.