The Impact of the Preoperative Mental Health Component Summary (MCS) Score on Short-term Outcomes after Lumbar Fusion

Teeto Ezeonu; Rajkishen Narayanan; Jeremy C Heard; Yunsoo A Lee; Aditya Mazmudar; M Jeffrey Zucker; Alexander Shaer; Yoni Dulitzki; Dylan Resnick; Jose A Canseco; Mark F Kurd; Ian David Kaye; Alan S Hilibrand; Alexander R Vaccaro; Christopher Kepler; Gregory D Schroeder

doi:10.1097/BRS.0000000000005064

The Impact of the Preoperative Mental Health Component Summary (MCS) Score on Short-term Outcomes after Lumbar Fusion

Spine (Phila Pa 1976). 2024 Jun 7. doi: 10.1097/BRS.0000000000005064. Online ahead of print.

Authors

Teeto Ezeonu¹, Rajkishen Narayanan¹, Jeremy C Heard¹, Yunsoo A Lee¹, Aditya Mazmudar¹, M Jeffrey Zucker², Alexander Shaer², Yoni Dulitzki², Dylan Resnick², Jose A Canseco¹, Mark F Kurd¹, Ian David Kaye¹, Alan S Hilibrand¹, Alexander R Vaccaro¹, Christopher Kepler¹, Gregory D Schroeder¹

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107.
² Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA 19107.

PMID: 38845385
DOI: 10.1097/BRS.0000000000005064

Abstract

Study design: Retrospective cohort study.

Objective: The purpose of this study is to characterize the relationship between preoperative MCS and surgical outcomes after lumbar spine surgery including inpatient complications, length of stay, readmissions, and reoperations.

Summary of background data: As the prevalence of mental health disorders in the United States increases, it is important to identify risks associated with poor mental health status in the surgical spine patient. The mental health component summary (MCS) of the Short Form-12 has been used extensively as an indication of a patient's mental health status and psychological well-being.

Methods: Adult patients older than or equal to 18 years who underwent primary one to three level lumbar fusion surgery at our academic medical institution from 2017 to 2021 were retrospectively identified. Preoperative MCS score was used to analyze outcomes in patients based on a cutoff (<45.6). A score >45.6 indicated better preoperative mental health and a score <45.6 indicated worse preoperative mental health.

Results: Patients with lower preoperative MCS scores had longer hospital stays (3.86 + 2.16 vs. 3.55 + 1.42 days, P=0.010) and were more likely to have inpatient renal complications (3.09% vs. 7.19%, P=0.006). Patients with lower preoperative MCS scores also had lower Activity Measure for Post-Acute Care (AM-PAC) scores (17.1 + 2.85 vs. 17.6 + 2.49, P=0.030). Ninety-day surgical readmissions, medical readmissions, and reoperations were not significantly different between groups (P>0.05).

Conclusion: Our study suggests that patients with lower preoperative mental health scores (MCS < 45.6) were independently more likely to experience more renal complications and longer length of stay after primary lumbar fusion. Additionally, higher MCS scores may correlate with better postoperative mobility and daily activity scores. Nevertheless, long-term outcomes are not significantly different between patients of better or worse preoperative mental health.