• Yuh Watanabe, Go Yoshida, Tomohiko Hasegawa, Yu Yamato, Daisuke Togawa, Tomohiro Banno, Shin Oe, Hideyuki Arima, Hiroki Ushirozako, Tomohiro Yamada, Hideyuki Murata, and Yukihiro Matsuyama.
• Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Shizuoka.
• Spine. 2020 Jan 15; 45 (2): E76-E82.

Study DesignA retrospective study.ObjectiveWe aimed to evaluate the impact of mental status on the clinical outcomes of patients with adult spinal deformity (ASD).Summary Of Background DataLimited information is currently available on how preoperative mental status affects postoperative health-related quality of life (HRQOL) in patients with ASD.MethodsWe enrolled 165 patients with ASD who underwent corrective surgery at a single university hospital between March 2010 and September 2015. We compared Scoliosis Research Society-22r (SRS-22r) and Oswestry Disability Index (ODI) scores using various x-ray parameters at these time points: preoperative period and postoperative 2 years. Additionally, to determine the associations between perioperative complications and mental health disorders, we examined these x-ray parameters: lumbar lordosis, thoracic kyphosis, sacral slope, pelvic incidence, pelvic tilt, sagittal vertical axis (SVA), and T1 pelvic angle (TPA).ResultsWe found correlations between the preoperative SRS-22r total score and preoperative ODI (r = -0.692, P < 0.01) and postoperative ODI (r = -0.443, P < 0.01). Preoperative SRS-22r mental domain correlated with preoperative ODI (r = -0.561, P ≤ 0.01) and postoperative ODI (r = -0.315, P ≤ 0.01). Perioperative (preoperative and postoperative) SRS-22r mental domain did not correlate with the postoperative x-ray parameters except for SVA and TPA. Postoperative mental health correlated with early infection (P < 0.05), hematoma (P < 0.05), deep vein thrombosis (P < 0.05), and delirium (P < 0.05). Regression analysis revealed that preoperative SRS-22r mental health score correlated with preoperative ODI (P < 0.001) and postoperative ODI (P < 0.001). The regression coefficient number between preoperative SRS-22r mental health score and perioperative (preoperative and postoperative) ODI improved from -17.3 to -10.2 from preoperative to postoperative periods.ConclusionDiminished preoperative mental health worsened postoperative HRQOL. Perioperative complications influence postoperative mental status and HRQOL; hence, screening preoperative mental health is important.Level Of Evidence3.

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