102 - Unsatisfactory Outcomes after Spine Surgery are Associated with New-Onset Depression and Substance Abuse Disorder in the First Year After Surgery

Introduction:
Unexpected outcomes after spine surgery, including persistent or new-onset pain, are a source of significant psychosocial stress for patients. Surgery is often seen as a “last resort” for patients that have completed a long course of non-surgical treatments, and failure of surgery to relieve pain can have a devastating impact on patients and their families. Previous studies have shown pre-operative psychological distress, opioid use and substance abuse disorders as risk factors for failure to achieve clinical improvement after spine surgery. However, there is limited current understanding of how a poor outcome after spine surgery can cause new-onset psychological or substance abuse disorders in patients who did not previously have those diagnoses. The purpose of this study is to determine the extent to which failure to achieve a desired outcome after spine surgery can predispose patients to a new diagnosis of depression or substance abuse disorder.

Methods:
The National Covid Cohort Collaborative (N3C) is a vast collection of clinical observations during the Covid-19 pandemic and includes procedural and diagnostic data across multiple medical subspecialties. A retrospective cohort of patients undergoing spinal surgery was identified using CPT procedural codes. We identified a subset of patients who received an ICD10 code of M96.1 following surgery, which is associated with diagnoses such as “failed back surgery syndrome” and “post-laminectomy” syndrome. We collected demographic information including age, gender, race, and ethnicity. Using ICD10 codes, we also identified whether patients received a new diagnosis of depression, opioid abuse disorder, cannabis abuse disorder, tobacco abuse disorder or alcohol abuse disorder in the first year following surgery.

Results:
A total of 17,445,128 patients were queried, of which 52,594 were found to have undergone spinal surgery. 769 patients were given a diagnosis code of M96.1, indicating an unsatisfactory outcome from the surgery. Patients with diagnosis code M96.1 had a significantly higher risk of new onset diagnoses of depression (OR 1.67, 95%CI [1.17,2.39]), opioid abuse disorder (OR 3.5, 95% CI [2.15, 5.22]), cannabis abuse disorder (OR 2.8, 95% CI [1.31, 5.96]), and tobacco abuse disorder (2.74, 95% CI [1.29, 5.86]). Patients with diagnosis code M96.1 did not have a significantly higher risk of new onset alcohol abuse disorder (OR .67 95% CI .21, 2.09]).

Conclusion:
Patients with an unsatisfactory outcome after spine surgery are at high risk for development of depression or substance abuse disorder in the first year after surgery. Possible strategies to limit these complications could include careful discussion of expectations prior to surgery, multimodal non-narcotic pain regimens, and psychological counseling for patients with persistent pain after surgery. Addressing this problem may require collaboration between spine surgeons and our colleagues in psychiatry or clinical psychology. Further research is urgently needed to limit the occurrence of these psychosocial complications in patients after spine surgery.