Mental health disorders in adolescent idiopathic scoliosis surgery: prevalence, postoperative outcomes, and opioid use.

BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is a common spinal deformity often presenting during a critical period for psychological development. While AIS has been associated with increased rates of mental health disorders (MHDs), postoperative outcomes in patients with preoperative MHDs undergoing AIS surgery remain poorly understood.

PURPOSE: This study aimed to identify the perioperative prevalence of MHDs and evaluate the impact of preoperative MHDs on surgical outcomes and healthcare utilization in adolescents undergoing AIS correction.

STUDY

DESIGN

Retrospective database study.

PATIENT SAMPLE: Patients aged 10-18 undergoing >7-level posterior spinal fusion for AIS between 2010 and 2023.

OUTCOME MEASURES: Epidemiologic measures: MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs.

METHODS

Our population of interest was identified in the PearlDiver national database. Patients were stratified by presence of MHDs within 1 year perioperatively, defined using DSM-5 categories. Outcomes included MHD prevalence pre- and postoperatively, hospital readmissions, surgical and medical complications, revision surgeries, postoperative opioid use, and healthcare utilization costs. Pre- and postoperative rates of MHDs were compared using McNemar's test. Propensity score matching (3:1) was performed based on age, sex, and Elixhauser Comorbidity Index (ECI), followed by univariate analyses.

RESULTS

Among 11,624 patients, 15.92% had a documented preoperative MHD. MHD prevalence rose in the year prior to surgery and remained stable within 1 year postoperatively. After matching, patients with MHDs had higher total opioid use, increased opioid use between 90 and 180 days postoperatively, and higher healthcare costs at 90 and 365 days. No significant differences were observed in complication, readmission, or revision surgery rates.

CONCLUSION

In our cohort, 15.92% of AIS patients were diagnosed with an MHD within 1 year preoperatively, a prevalence that remained stable postoperatively. While AIS surgery is safe in patients with preoperative MHDs, these individuals experience higher total opioid use and greater healthcare utilization. Future research should aim to identify specific drivers of healthcare utilization in patients with MHDs and evaluate the impact of targeted mental health interventions on both psychological well-being and physical recovery to optimize outcomes for AIS patients.