Association between baseline affective disorders and 30-day readmission found in elective spinal surgery patients

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Psychological disorders, such as depression and anxiety, have been independently associated with higher all-cause 30-day readmission rates after elective spine surgery, in research presented at the 2016 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.

Winning the Robert Florin Resident Award, the research was presented by Owoicho Adogwa (Raleigh, USA).

In 2013, the US Centers for Medicare & Medicaid Services (CMS) implemented the hospital readmission reduction policy, which penalises US hospitals for “excessive” all-cause hospital readmissions within 30 days after discharge. The current study investigated the influence of psychiatric comorbidities on 30-day all-cause readmissions following elective spinal surgery. The authors suggest that patients with high baseline affective disorders are most likely to be readmitted within 30 days of discharge.

The medical records of 400 patients undergoing elective spinal surgery at a major academic medical centre were reviewed. Of the 400, comprehensive one- and two-year patient reported outcomes data was available for 107 patients. The authors identified all unplanned readmissions within 30 days of discharge. The prevalence of affective disorders, such as depression and anxiety, were also assessed. The authors had hypothesised that depression and anxiety are independently associated with an increased risk of 30-day readmission after elective spinal surgery. All-cause readmissions within 30 days of discharge was the primary outcome variable.

The data indicated that baseline characteristics were similar between both groups. Approximately 6% of patients were readmitted within 30 days of discharge. The rate of readmission was three-fold greater for individuals with a psychiatric comorbidity compared with those without a psychiatric comorbidity. In a univariate analysis, race, body mass index, gender, patient age, smoking, diabetes and fusion levels were associated with increased 30-day readmission rates. However, in a multivariate logistic regression model, depression was an independent predictor of readmission within 30 days of discharge. Additionally, there were no significant differences in baseline, one- and two-year patient reported outcomes measures between both groups.

Psychological disorders, such as depression and anxiety, are independently associated with higher all-cause 30-day readmission rates after elective spinal surgery. The study concluded that mental health components should be added to future interventions to reduce readmission.