PMID- 38171050
OWN - NLM
STAT- MEDLINE
DCOM- 20240205
LR  - 20240206
IS  - 1872-6968 (Electronic)
IS  - 0303-8467 (Linking)
VI  - 236
DP  - 2024 Jan
TI  - Influence of affective disorders on outcomes after suboccipital decompression for 
      adult Chiari I malformation.
PG  - 108104
LID - S0303-8467(23)00520-6 [pii]
LID - 10.1016/j.clineuro.2023.108104 [doi]
AB  - INTRODUCTION: Affective disorders (AD) have been shown to influence patient 
      outcomes and healthcare resource utilization across several pathologies, though 
      this relationship has not been described in patients with Chiari I malformations 
      (CM-I). The aim of this study was to determine the impact of comorbid AD on 
      postoperative events and healthcare resource utilization in adults following 
      suboccipital decompression for CM-I. METHODS: A retrospective study was performed 
      using the 2016-2019 National Inpatient Sample database. Adults who underwent 
      suboccipital decompression for CM-I were identified using ICD-10-CM codes. 
      Patients were stratified into two cohorts, those with AD and those without (No 
      AD). Patient demographics, comorbidities, operative characteristics, 
      perioperative adverse events (AEs), and healthcare resource utilization were 
      assessed. Multivariate logistic regression analyses were used to identify 
      independent predictors of prolonged length of stay (LOS), exorbitant admission 
      costs, and non-routine discharge (NRD). RESULTS: A total of 3985 patients were 
      identified, of which 2780 (69.8%) were in the No AD cohort and 1205 (30.2%) were 
      in the AD cohort. Patient demographics were similar, except for a greater 
      proportion of Female patients than the No AD cohort (p = 0.004). Prevalence of 
      some comorbidities varied between cohorts, including obesity (p = 0.030), ADHD 
      (p < 0.001), GERD (p < 0.001), smoking (p < 0.001), and chronic pulmonary disease 
      (p < 0.001). The AD cohort had a greater proportion of patients with 1-2 
      (p < 0.001) or >/= 3 comorbidities (p < 0.001) compared to the No AD cohort. A 
      greater proportion of patients in the AD cohort presented with headache compared 
      to the No AD cohort (p = 0.003). Incidence of syringomyelia was greater in the No 
      AD cohort (p = 0.002). A greater proportion of patients in the No AD cohort 
      underwent duraplasty only (without cervical laminectomy) compared to the AD 
      cohort (p = 0.021). Healthcare resource utilization was similar between cohorts, 
      with no significant differences in mean LOS (No AD: 3.78 +/- 3.51 days vs. 
      3.68 +/- 2.71 days, p = 0.659), NRD (No AD: 3.8% vs. AD: 5.4%, p = 0.260), or mean 
      admission costs (No AD: $20,254 +/- 14,023 vs. AD: $29,897 +/- 22,586, p = 0.284). On 
      multivariate analysis, AD was not independently associated with extended LOS [OR 
      (95%CI): 1.09 (0.72-1.65), p = 0.669], increased hospital costs [OR (95%CI): 0.98 
      (0.63-1.52), p = 0.930], or NRD [OR (95%CI): 1.39 (0.65-2.96), p = 0.302]. 
      CONCLUSION: Our study suggests that the presence of an AD may not have as much of 
      an impact on postoperative events and healthcare resource utilization in adult 
      patients undergoing Chiari decompression. Additional studies may be warranted to 
      identify other potential implications that AD may have in other aspects of 
      healthcare in this patient population.
CI  - Copyright (c) 2024 Elsevier B.V. All rights reserved.
FAU - Sherman, Josiah J Z
AU  - Sherman JJZ
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Sayeed, Sumaiya
AU  - Sayeed S
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Craft, Samuel
AU  - Craft S
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Reeves, Benjamin C
AU  - Reeves BC
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Hengartner, Astrid C
AU  - Hengartner AC
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Fernandez, Tiana
AU  - Fernandez T
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Koo, Andrew B
AU  - Koo AB
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - DiLuna, Michael
AU  - DiLuna M
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA.
FAU - Elsamadicy, Aladine A
AU  - Elsamadicy AA
AD  - Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, 
      USA. Electronic address: aladine.elsamadicy@yale.edu.
LA  - eng
PT  - Journal Article
DEP - 20231227
PL  - Netherlands
TA  - Clin Neurol Neurosurg
JT  - Clinical neurology and neurosurgery
JID - 7502039
SB  - IM
MH  - Adult
MH  - Humans
MH  - Female
MH  - *Decompression, Surgical/adverse effects
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Hospital Costs
MH  - *Arnold-Chiari Malformation/epidemiology/surgery/complications
MH  - Postoperative Complications/etiology
OTO - NOTNLM
OT  - Affective disorder
OT  - Chiari I malformation
OT  - Suboccipital decompression
COIS- Declaration of Competing Interest None.
EDAT- 2024/01/04 11:43
MHDA- 2024/02/05 06:44
CRDT- 2024/01/03 18:00
PHST- 2023/07/03 00:00 [received]
PHST- 2023/12/25 00:00 [revised]
PHST- 2023/12/25 00:00 [accepted]
PHST- 2024/02/05 06:44 [medline]
PHST- 2024/01/04 11:43 [pubmed]
PHST- 2024/01/03 18:00 [entrez]
AID - S0303-8467(23)00520-6 [pii]
AID - 10.1016/j.clineuro.2023.108104 [doi]
PST - ppublish
SO  - Clin Neurol Neurosurg. 2024 Jan;236:108104. doi: 10.1016/j.clineuro.2023.108104. 
      Epub 2023 Dec 27.