Impact of psychiatric comorbidities on outcomes following intervention for lumbar degenerative disc disease

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Online supplement

Impact of psychiatric comorbidities on outcomes following intervention for lumbar degenerative disc disease

Piyush Kalakoti MD,*¹ Daniel M. Sciubba MD,†¹ Andrew J. Pugely MD,‡¹ Matthew J. McGirt MD,^§ Kanika Sharma MD,* Devi P Patra MD,* Kevin Phan BSc,^¶ Karthik Madhavan MD,^|| Richard P. Menger MD, MPA,* Christina Notarianni MD,* Bharat Guthikonda MD,* Anil Nanda MD, MPH,* Hai Sun MD, PhD*

1Authors contributed equally to the work and are co-primary authors

*Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA

†Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD

‡Spine Surgery, Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA §Neurological Surgery, Carolina Neuro- surgery and Spine Associates, Charlotte, NC

¶NeuroSpine Surgery Research Group (NSURG), Sydney, Australia

||Neurosurgery, Miller School of Medicine, University of Miami, FL, USA

Cover title: Psychiatric comorbidities and outcomes in LDDD

Key-words: Psychiatric comorbidities; lumbar fusion; degenerative disc disorder; depression; bipolar disorders; anxiety disorders; schizophrenia; personality disorders, dissociative and somatoform disorders; outcomes; NIS

Tables: 02; Figure: 01; Online supplement: 01

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Table of Contents

SUPPLEMENTAL TABLES………...………...………4

- Table S1: Coding Definitions (ICD-9-CM codes)………..……..…...4-5 - Table S2: Estimates of missing data for explanatory variables used for model development………..….….6

SUPPLEMENTAL FIGURE ………...………...………7 - Figure S1: Association of psychiatric comorbidities with outcomes following lumbar arthrodesis in patients with degenerative

disc disease using non-imputed datasets.………..………..……..…...7

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Table S1. Coding Definitions (ICD-9-CM codes)

GROUP CATEGORY CODES NOTES/CODING

RULES

Procedures Primary lumbar fusions 81.04-81.08 ICD-9 Procedure codes

Repeat lumbar fusions (redo) 81.34-81.38 ICD-9 Procedure codes

Diagnosis:

Lumbar degenerative pathologies

Lumbar spondylosis 721.3, 721.4, 721.42, 756.11 ICD-9 Diagnosis codes

Schmorl’s nodes, lumbar region 722.32 ICD-9 Diagnosis codes

Lumbar disc degeneration 722.5, 722.51, 722.52, ICD-9 Diagnosis codes

Spondylolisthesis 738.4, 756.12 ICD-9 Diagnosis codes

Independent exposure (model) variables

Primary exposure of interest -

Psychiatric diseases:

Depression Bipolar disorders Schizophrenia

Anxiety, dissociative &

somatoform disorders Personality Disorders

296.2-296.3x, 296.82, 298.0, 311 296.0-296.1x, 296.4-296.81, 296.89 295, 295.x, 295.xx

300-300.xx 301-301.xx

ICD-9 Diagnosis codes ICD-9 Diagnosis codes ICD-9 Diagnosis codes ICD-9 Diagnosis codes ICD-9 Diagnosis codes

Sex -

Age -

Stroke 434.91, 434.11, 434.01, 430-432 ICD-9 Diagnosis codes

CAD 410, 410.0-410.9, 411, 411.1, 411.89, 412, 413, 413.1, 413.9, 414, 414.2, 414.3, 414.4, 414.8, 414.9

ICD-9 Diagnosis codes

Chronic pulmonary disease 490-492.8, 493.00-493.91, 494, 495.0-505, 506.4 ICD-9 Diagnosis codes CHF 398.91, 402.11, 402.91, 404.11, 404.13, 404.91,

404.93, 428.0-428.9 ICD-9 Diagnosis codes

DM 250.00-250.33, 250.40-250.73, 250.90-250.93 ICD-9 Diagnosis codes

Coagulopathy 286.0-286.9, 287.1, 287.3-287.5 ICD-9 Diagnosis codes

CRF 585, 586, V42.0, V45.1, V56.0, V56.8 ICD-9 Diagnosis codes

Hypertension 401, 402, 403, 404 ICD-9 Diagnosis codes

Hypercholesterolemia 272, 272.0, 272.1, 272.2, 272.3, 272.4 ICD-9 Diagnosis codes

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Obesity 278.00, 278.01 ICD-9 Diagnosis codes Alcohol abuse 291.1, 291.2, 291.5, 291.8, 291.9, 303.90-303.93,

305.00-305.03, V113 ICD-9 Diagnosis codes

PVD 440.00-440.9, 441.2, 441.4, 441.7, 441.9, 443.1-

443.9, 447.1, 557.1, 557.9, V43.4 ICD-9 Diagnosis codes

Plegia 344.0, 344.00-344.04, 344.09, 344.1, 344.2,

344.3, 344.30-344.32, 344.4, 344.40-344.42, 344.5, 344.6, 344.60, 344.61, 344.8, 344.81, 344.89, 344.9

Bowel/Bladder dysfunction 787.6, 787.60, 788.2, 788.20, 788.29, 788.31-

788.33, 788.39, 788.41, 788.61, 788.63-788.65 ICD-9 Diagnosis codes

Sensory deficit 782.0 ICD-9 Diagnosis codes

Myelopathy 336.3, 336.8, 336.9 ICD-9 Diagnosis codes

Osteoporosis 733, 733.00-733.03, 733.09; V58.65 ICD-9 Diagnosis codes Outcomes

(complications) Unfavorable discharge*

(DISPUNIFORM) - -

Length of hospital stay * Metric endpoint -

Hospitalization Cost* Metric endpoint -

Neurological complications including dural tears and nerve root injury*

349.1, 349.3, 349.31, 349.39, 953.0-953.9, 996.2,

996.75, 997.0, 997.00- 997.02, 997.09 ICD-9 Diagnosis codes Venous thromboembolic events * 415.1, 415.11, 415.13, 415.19, V12.51, 451.1,

451.11, 451.19, 451.2, 451.81, 451.9, 453.2- 453.4, 453.6, 453.8, 453.81-453.89, 453.9 38.7

ICD-9 Procedure code Wound complications* 998.10-998.19, 998.30-998.39 ICD-9 Diagnosis codes Wound infections* 996.6, 996.63, 998.02, 998.5, 998.51, 998.59, ICD-9 Diagnosis codes Gastro-intestinal complications* 997.4, 997.41, 997.49 ICD-9 Diagnosis codes

Cardiac complications* 997.1 ICD-9 Diagnosis codes

Respiratory complications* 518.51-518.53, 518.81, 518.82, 518.84, 997.3,

997.31, 997.32, 997.39, 998.81 ICD-9 Diagnosis codes

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ARF* 584, 584.5, 584.6, 584.7, 584.8, 584.9 ICD-9 Diagnosis codes

*Patients that died during hospitalization were excluded

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Table S2: Proportion of missing data for the explanatory variables in the study cohort

Covariates Proportion

Race 22.2%

Median income quartiles 2.1%

Hospital bedsize 0.5%

Payer 0.2%

Sex 0.1%

Age 0.03%

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Figure S1: Association of psychiatric comorbidities with outcomes following lumbar arthrodesis in patients with degenerative disc disease using non-imputed dataset