Evaluation of the Impact of Medical and Psychiatric Comorbidities on Long-term Postoperative Spinal Surgery Outcomes

Study Design: Retrospective cohort study. Objective: This study examined how depression, anxiety, diabetes, and hypertension influence outcomes in elective spine surgery patients over time. Summary of Background Data: Chronic medical comorbidities can affect peri- and postoperative outcomes, but their impact on presurgical attitudes and recovery remains unclear. Methods: From August 2021 to August 2022, 127 elective spine surgery patients at a single academic center completed a preoperative survey assessing social support, affordability, trust in health care, and surgical attitudes. Comorbidity effects on outcomes were evaluated at 3, 6, 9, and 12 months using descriptive and regression analyses. Results: The cohort (mean age 68.1±10.9 years, 55.9% male) included patients with anxiety (25.2%), depression (29.1%), diabetes (18.9%), and hypertension (60.6%). Anxiety (aOR 1.66, 95% CI: 1.06–2.59, P =0.026) and depression (aOR 1.56, 95% CI: 1.01–2.43, P =0.047) correlated with lower social support. Both conditions predicted higher outpatient complications (anxiety aOR 5.52, 95% CI: 1.42–23.9, P =0.006; depression aOR 4.41, 95% CI: 1.15–18.8, P =0.017), readmissions (anxiety aOR 5.67, 95% CI: 1.47–24.3, P =0.005; depression aOR 4.84, 95% CI: 1.27–20.6, P =0.011), and ER visits within six weeks. Diabetes strongly predicted discharge to skilled nursing facilities (aOR 13.1, 95% CI: 0.99–717, P =0.027) and delayed early improvement at three months (aOR 0.12, 95% CI: 0.00–1.02, P =0.029), which resolved by six months. At twelve months, hypertension was linked to elevated VAS back pain (aOR 2.40, 95% CI: 1.13–5.08, P =0.022). Conclusion: Medical comorbidities were significantly associated with adverse spine surgery outcomes, highlighting the importance of early preoperative identification and intervention.