Psychosocial Variables Contribute to Length of Stay and Discharge Destination After Lumbar Surgery Independent of Demographic and Clinical Variables.
Academic Article
Overview
abstract
STUDY DESIGN: Prospective analysis of resource utilization (RU) after lumbar surgery. OBJECTIVE: To determine contributions of patient psychosocial variables to RU, specifically length of stay (LOS) and discharge destination. SUMMARY OF BACKGROUND DATA: Associations between demographic/clinical variables and RU are well-established; less is known about associations between psychosocial variables, such as social support and depressive/anxiety symptoms, and RU. METHODS: Preoperatively 532 patients provided standard ratings of depressive and anxiety symptoms and amount of social support. Clinical variables included calculation of a composite score reflecting invasiveness of surgery. Two outcomes were considered: LOS ≤ 3 or > 3 days; and discharged home without external services or discharged with external services. Independent variables in multivariable logistic models were demographic/clinical and psychosocial variables. RESULTS: Mean age was 56 years, 55% were men, 87% had degenerative conditions, 40% had a positive depression screen, 62% had anxiety greater than population norms, and 77% reported as much social support as wanted. Variables that remained associated with a LOS > 3 days (53%) in multivariable analysis were: older age (OR 1.8, confidence interval, CI, 1.2-2.8); female sex (OR 1.9, CI 1.2-2.9), less social support (OR 1.4, CI 1.1-1.7); obesity (OR 1.8, CI 1.1-2.8), worse functional status (OR 1.0, CI 1.0-1.0), and more invasive surgery (OR 3.0, CI 2.4-3.7). Variables that remained associated with discharged with external services (17%) in multivariable analysis were: older age (OR 3.3, CI 1.9-5.9); less social support (OR 1.3, CI 1.0-1.7); positive depression screen (OR 1.9, CI 1.1-3.4); more anxiety (OR 2.4, CI 1.3-4.2); major comorbidity (OR 1.7, CI 1.0-2.8); and more invasive surgery (OR 1.9, CI 1.5-2.5). CONCLUSION: This study confirms the importance of demographic/clinical variables as predictors of greater RU after lumbar surgery and provides preliminary evidence for the importance of concurrent psychosocial variables, particularly less social support, and worse psychological well-being. LEVEL OF EVIDENCE: 2.
