O1045: The Impact of Mental Health on Post-operative Outcomes for Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis at a Tertiary Care Children’s Hospital in an Underserved Region

Background: In recent years, the orthopedic community has strived to better understand the impact of psychosocial variables on musculoskeletal conditions. This is in part due to the rising awareness and prevalence of psychosocial variables and their impacts, particularly within the pediatric population. In the United States alone, one in five patients aged 13-18 has experienced or are currently experiencing a mental or substance use disorder. These disorders are often influenced by factors such as anxiety, resilience, and self-esteem. Within the field of orthopedic surgery, studies in adult patients have shown that pre-surgical depression or anxiety can lead to post-operative pain and new-onset mental illnesses. In this retrospective study, we seek to evaluate this association in pediatric patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion (AIS-PSF) and identify correlations between pre-operative mental health and post-operative well-being.

Methods: After IRB approval, we analyzed the retrospective chart review of 258 AIS-PSF patients (mean age 14.9±2.09, 75.9% female), at the Children’s Hospital at Montefiore from 2013-2019. Patients were asked to complete disease-specific surveys (SRS-30 or SRS-22) throughout their pre- and post-operative course. Survey responses were synthesized into composite scores for function, pain, self-image, mental health, and care satisfaction. Pearson bivariate correlations identified correlations between pre- and post-operative survey domains.

Results: Bivariate analyses demonstrated associations at the 0.01-significance level between: pre-operative mental health and pre-operative pain (r=0.518); pre-operative mental health and 6-week post-operative mental health (r=0.476); 6-week post-operative mental health and 6-month post-operative mental health (r=0.765); and 6-month post-operative mental health and 6-month post-operative self-image (r=0.705). Additionally, 6-week post-operative mental health was significantly associated with 6-month post-operative pain at p=0.05 (r=0.605). Of note, it was discovered that between pre-operative and 6-week post-operative assessments, 28.8% of patients had worse mental health scores (while 55.8% reported improved mental health and 12.5% reported no change) figure (1), and between pre-operative and 6-month post-operative assessments, 32.3% of patients had worse mental health scores (while 55.9% reported improved mental health and 11.8% had no change) figure(2).

Conclusion: Predictive factors such as mental health status and per¬ception of pain for postoperative outcomes have been demonstrated in the literature as key risk factors to medical treatment adherence, partic¬ipation, rehabilitation and surgical outcomes. AIS-PSF patients with low pre-operative mental health scores were more likely to have worse mental health, self-image, and pain scores post-operatively. Furthermore, nearly one-third of patients reported worsened mental health following surgery. Our results support the growing literature on the interconnectedness of physical disease, mental health, and general well-being. These results will serve as a foundation from which we plan to develop a comprehensive, multidisciplinary program to identify and address psychosocial stressors faced by our patients both pre- and post-operatively, with the goal of improving long-term outcomes.