【Introduction】
Patients undergoing spinal surgery while being treated for a psychiatric disorder often experience difficulties with perioperative management owing to their inability to communicate effectively. This state of affairs may lead to postoperative complications.
【Methods】
Fifty-five patients with a psychiatric disorder requiring continuous treatment who underwent spinal surgery between January 2014 and October 2021 were included (nail extraction and cleaning were excluded), and those who were able to be followed for at least two years were retrospectively surveyed. The patients’ average age was 46 years (range: 18-88 years), the male-to-female ratio was 23:32, and 25 and 30 had a traumatic and a degenerative disease, respectively. The main survey items were surgical technique, concomitant psychiatric disorder, postoperative complications, and length of hospital stay. Thirty-five and three patients with a traumatic and degenerative disease, respectively, without a psychiatric disorder during the study period who were matched for age and sex were selected as a control group.
【Results】
The study group consisted of nine patients with decompression surgery without instrumentation and 46 patients with fixation surgery with instrumentation. The psychiatric disorders included schizophrenia, depression, and bipolar disorder in 33, 17, and 5 patients, respectively. Four patients experienced a deterioration of their psychiatric illness during hospitalization (involving transfer to a psychiatric ward), and 42 patients (76%) required postoperative physical restraint.
The complication rate in the study group was 16.3% (9/55), with many of the complications, such as paralytic ileus and aspiration pneumonia, suspected of being related to physical restraint. On the other hand, in the control group the rate of complications, including postoperative wound infection, wound fusion failure, and implant loosening, was 12.3% (8/65). No significant correlation was found between the postoperative deterioration of mental illness and the complication rate. The postoperative duration of hospitalization was 35.6 and 28.7 days in the study group and control group, respectively.
【Discussion】
Spinal surgery in patients with a psychiatric comorbidity is safe, with the complication rate not differing significantly from that of patients without a psychiatric comorbidity. The postoperative complications seen in the present study may have stemmed from the use of physical restraints. The length of hospitalization tended to be longer in patients with complications than in those without them, possibly because the former were unable to be transferred to a rehabilitation hospital equipped to perform follow-up examinations for postoperative psychiatric disorders.