Depression and anxiety as emerging contributors to increased hospital length of stay after posterior spinal fusion in patients with adolescent idiopathic scoliosis

Abstract Background Context The diagnosis of generalized anxiety disorder (GAD) and major depressive disorder (MDD) amongst adolescents is rising worldwide. Rates of these disorders are higher in those with adolescent idiopathic scoliosis. Purpose To elucidate whether or not depression and anxiety are associated with increased length of stay and total cost after posterior spinal fusion for adolescent idiopathic scoliosis. Study Design/Setting, Patient Sample This study utilized the Nationwide Inpatient Sample (NIS) to obtain a sample of n = 564 in the depression and anxiety cohort and n = 5,185 in the cohort without concomitant diagnosis of depression and anxiety. Outcome Measures Length of stay and total cost after posterior spinal fusion for adolescent idiopathic scoliosis. Methods The Nationwide Inpatient Sample (NIS) was queried for patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis with either the concomitant diagnosis of major depressive disorder or generalized anxiety disorder. Comorbidities and other confounders were controlled for using multivariate regression analysis to determine the effect of having either mood disorder on cost and length of stay (LOS) after PSF. Results We determined that after controlling for confounding variables and comorbidities through multivariate regression analysis, patients with either depression or anxiety had increased odds ratios for increased LOS but not for cost. Conclusions The emergence of adolescent MDD and GAD may have significant implications on the inpatient stay for patients undergoing major surgery, including PSF for adolescent idiopathic scoliosis.