Abstract
Depression is associated with poorer outcomes in a wide spectrum of surgeries but the specific effects of depression in patients undergoing cervical spine surgery are unknown. This study aimed to evaluate the prevalence and impact of pre-surgical clinical depression on pain and other outcomes after surgery for cervical degenerative disc disease using a national representative database. Data of patients with cervical myelopathy and radiculopathy were extracted from the 2005–2014 US Nationwide Inpatient Sample (NIS) database. Included patients underwent anterior discectomy and fusion (ACDF). Acute or chronic post-surgical pain, postoperative complications, unfavorable discharge, length of stay (LOS) and hospital costs were evaluated. Totally 215,684 patients were included. Pre-surgical depression was found in 29,889 (13.86%) patients, with a prevalence nearly doubled during 2005–2014 in the US. Depression was independently associated with acute or chronic post-surgical pain (aOR: 1.432), unfavorable discharge (aOR: 1.311), prolonged LOS (aOR: 1.152), any complication (aOR: 1.232), respiratory complications/pneumonia (aOR: 1.153), dysphagia (aOR: 1.105), bleeding (aOR: 1.085), infection/sepsis (aOR: 1.529), and higher hospital costs (beta: 1080.640) compared to non-depression. No significant risk of delirium or venous thrombotic events was observed in patients with depression as compared to non-depression. Among patients receiving primary surgery, depression was independently associated with prolonged LOS (aOR: 1.150), any complication (aOR:1.233) and postoperative pain (aOR:1.927). In revision surgery, no significant associations were found for prolonged LOS, any complication or pain. In conclusion, in the US patients undergoing ACDF, pre-surgical clinical depression predicts post-surgical acute or chronic pain, a slightly prolonged LOS and the presence of any complication. Awareness of these associations may help clinicians stratify risk preoperatively and optimize patient care.
Highlights
Depression and anxiety are the two most commonly diagnosed mental health conditions worldwide, often manifesting together
Sponsorship is provided by the Agency for Healthcare Research and Quality (AHRQ) and the program is administered by the Healthcare Cost and Utilization Project (HCUP) of the National Institutes of Health (NIH) [17], Data provided for all patients include demographics, primary and secondary diagnoses, primary and secondary procedures, admission and discharge status, expected payment source, duration of hospital stay, and hospital-related characteristics
Depression and cervical spine surgery adults 18 years old or older diagnosed with cervical degenerative diseases and admitted for surgical treatment by ACDF
Summary
Depression and anxiety are the two most commonly diagnosed mental health conditions worldwide, often manifesting together. Results of a prior review revealed that several specific interacting factors (i.e., pain, disability, mental health status, lack of information and return to work) were associated with depression and anxiety symptoms both before and after spinal surgery, having more information about their condition seemed to help regulate patients’ depression and anxiety to some extent [8]. It was reported surgery for spinal stenosis relieved depressive symptoms in some patients, but poorer clinical outcomes were common in patients with more persistent postoperative depression [9]
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