# The Association of Poor Preoperative Mental Health and Outcomes After Surgical Correction of Adult Spinal Deformity: A Systematic Review and Meta Analysis

## TL;DR

Poor mental health before surgery for adult spinal deformity is linked to higher complication risks and worse disease severity, but similar quality of life improvements after surgery.

## Contribution

This study is the first systematic review and meta-analysis to quantify the impact of preoperative mental health on surgical outcomes for adult spinal deformity.

## Key findings

- Patients with poor mental health had higher odds of postoperative complications.
- Preoperative mental health was not associated with significant differences in postoperative quality of life improvements.
- Poor mental health correlated with worse preoperative and postoperative disease severity.

## Abstract

Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical outcomes remains poorly understood. We conducted a systematic review and meta-analysis to examine the association between preoperative mental health and outcomes following surgical correction for ASD. Methods: A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was performed from inception to April 2025 to identify studies investigating the relationship between preoperative mental health and postoperative health-related quality of life outcomes or complications. Data was pooled using a restricted maximum likelihood (REML) random-effects model. Heterogeneity was assessed using Cochran’s Q statistic, and between-study variance was reported as τ2. Study quality was assessed with the Newcastle–Ottawa Scale, and risk of bias was evaluated using the ROBINS-I tool. Results: Twenty-four studies comprising a total of 248,427 patients met inclusion criteria. In pooled analyses, patients with poor preoperative mental health showed comparable improvements in health-related quality of life measures after surgery (standardized mean difference [SMD] −0.04, 95% CI −0.30 to 0.22; I2 = 91.5%, τ2 = 0.42) and in pain scores (SMD −0.15, 95% CI −0.42 to 0.11; I2 = 71.8%, τ2 = 0.09). However, patients with poor mental health had significantly higher odds of postoperative complications (odds ratio [OR] 1.44, 95% CI 1.23 to 1.67; I2 = 97.4%, τ2 = 0.08). These patients also demonstrated worse preoperative disease severity (SMD –0.94, 95% CI −1.41 to −0.47; I2 = 95.5%, τ2 = 1.64) and worse postoperative disease severity (SMD –0.34, 95% CI −0.44 to −0.25; I2 = 48.9%, τ2 = 0.03). Conclusions: While patients with poor preoperative mental health have a greater disease severity both before and after ASD surgery, they appear to experience comparable benefits from surgical intervention compared to those without. Recognizing and managing mental health may be useful in preoperative management of ASD patients. Further prospective studies to further elucidate these associations are necessary.