New-Onset Psychiatric Disorders After Lumbar Fusion: Predictors, Timing, and Risk Stratification

Area of Science:

• Neurosurgery
• Psychiatry
• Health Services Research

Background:

• Lumbar fusion surgery is a common procedure for spinal conditions.
• Postoperative complications can significantly impact patient recovery and quality of life.

Purpose of the Study:

• To determine the incidence, timing, and predictors of new-onset psychiatric disorders after lumbar fusion.
• To develop a risk stratification model for early identification of at-risk patients.

Main Methods:

• Retrospective cohort study using the Nationwide Readmissions Database (2016-2019).
• Inclusion of adult patients undergoing elective inpatient lumbar fusion, excluding those with prior psychiatric diagnoses.
• Analysis of new-onset depression, anxiety, suicidal ideation, and homicidal ideation within 12 months post-surgery.

Main Results:

• Over 839,000 patients, 12,011 developed depression and 11,828 anxiety.
• Most psychiatric diagnoses occurred within 90 days, peaking around 3 weeks post-surgery.
• Opioid use and Medicaid insurance were significant predictors of psychiatric disorders, particularly suicidal ideation.

Conclusions:

• New-onset psychiatric disorders are frequent early complications following lumbar fusion.
• Modifiable factors like perioperative opioid use and demographic factors like socioeconomic status predict risk.
• Structured mental health screening and risk stratification are crucial for early intervention and improved patient outcomes.