Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Oct 13;8(1):66-72.
doi: 10.22603/ssrr.2023-0138. eCollection 2024 Jan 27.

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

Matthew J Walker  1 , Philip M Parel  1 , Alisa Malyavko  1 , Amy Zhao  1 , Theodore Quan  1 , Caillin Marquardt  1 , Addisu Mesfin  2 , Tushar C Patel  3
Affiliations

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

Matthew J Walker et al. Spine Surg Relat Res. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow diagram showing exclusion and inclusion criteria.
Figure 2.
Figure 2.
Cumulative incidence of depression for patients in the lumbar fusion and irrigation and debridement cohorts.
Figure 3.
Figure 3.
Cumulative incidence of stress disorders for patients in the lumbar fusion and irrigation and debridement cohorts.
Figure 4.
Figure 4.
Cumulative incidence of anxiety disorders for patients in the lumbar fusion and irrigation and debridement cohorts.
See this image and copyright information in PMC

References

    1. Fotis G. Souslian & Puja D. Patel (2021) Review and analysis of modern lumbar spinal fusion techniques, British Journal of Neurosurgery, DOI: 10.1080/02688697.2021.1881041 - DOI - PubMed
    1. Singla AMD, Qureshi RBS, Chen DQ, et al. Risk of surgical site infection and mortality following lumbar fusion surgery in patients with chronic steroid usage and chronic methicillin-resistant staphylococcus aureus infection. Spine. 2019;44(7):E408-13. - PubMed
    1. Kobayashi KMD, Imagama S, Ando K, et al. Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study. Spine. 2020;45(20):1459-66. - PubMed
    1. Andersson AE, Bergh I, Karlsson J, et al. Patients' experiences of acquiring a deep surgical site infection: an interview study. Am J Infect Control. 2010;38(9):711-7. - PubMed
    1. Perencevich EN, Sands KE, Cosgrove SE, et al. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003;9(2):196-203. - PMC - PubMed

LinkOut - more resources