Impact of post-traumatic stress disorder on clinical outcomes following lumbar interbody spinal fusion.

BACKGROUND

The purpose of this study was to investigate the association between post-traumatic stress disorder (PTSD) and adverse clinical events following lumbar interbody fusion surgery.

METHODS

A multi-institutional electronic medical record database was queried for patients undergoing lumbar interbody fusion surgery. The primary cohort of interest consisted of adult patients with a pre-operative diagnosis of PTSD. Propensity score matching was performed using demographics and comorbidities to generate matched controls. Patients with spine neoplasms, trauma, osteomyelitis, and inflammatory conditions were excluded. Short-term and long-term comparisons between cohorts were made with Chi-squared and independent t-tests.

RESULTS

After propensity matching, there were 2,572 patients included in this study, which were evenly distributed between the PTSD and control cohorts. At ninety-days, patients with PTSD demonstrated higher rates of opioid utilization (OR:1.8, 95% CI:1.2-2.7; P = 0.005) and emergency department utilization (OR:1.5, 95% CI:1.2-1.8; P < 0.001) compared to patients in the control group. There were similar rates of medical complications between the two groups at thirty- and ninety-days (P > 0.05). At two-years, patients in the PTSD cohort demonstrated similar rates of mortality (OR:1.0, 95% CI:0.5-2.2; P = 1.0) and lumbar spine reoperation (OR:0.9, 95% CI:0.7-1.2; P = 0.392) compared to patients in the control group.

CONCLUSIONS

Patients with PTSD demonstrated higher rates of emergency department utilization and opioid utilization following lumbar interbody fusion surgery. Additional research is needed to develop multi-disciplinary strategies to optimize clinical outcomes following lumbar spine surgery among patients with PTSD.