Mental Health Rather than Mental Disorders as a Predictor of Immediate Postoperative Recovery After Elective Lumbar Fusion: Using the PROMIS-10 Global Mental Health T Score.

Abstract

Retrospective comparative cohort. Investigate how a patient's mental health, as measured using the PROMIS-10 Global Mental Health T score (MHT), influences their in-hospital recovery after elective 1- to 2-level lumbar fusion. The intersection of mental and physical health among candidates for lumbar fusion has increased. Although there is strong evidence to suggest mental disorders can influence a patient's postoperative recovery, there is a paucity of information detailing the association between unrecognized low mental health and surgical outcomes. The MHT may provide a more nuanced insight into a patient's preoperative mental health status. A total of 637 patients who underwent 1- or 2-level elective lumbar fusion between April 2020 and June 2023 were analyzed for this study. Patients were stratified by their MHT (above average [AA] >50, control 40 to 50, below average [BA] <40) regardless of mental illness diagnosis. Outcome measures including pain scores both during activity and at rest, opioid consumption during the in-hospital stay, and ambulation distance were compared among groups using both univariate and multivariate models to control for confounders. The majority of patients reported average (41.4%) to above-average (35.3%) mental health. After controlling for confounders, findings suggested that patients in the BA group reported higher pain, consumed more opioids, and had shorter ambulation distances than patients in the AA group ( P =0.004, P =0.008, and P =0.020, respectively). Patients in the AA group were 84% less likely to be discharged to a facility than the BA group ( P =0.001). The MHT was an independent predictor of immediate postsurgical recovery, whereas a mental disorder diagnosis was not. A preoperative MHT <40 may represent an additional risk factor that has not previously been identified in patients undergoing elective lumbar fusion.