A national snapshot of the impact of clinical depression on post-surgical pain and adverse outcomes after anterior cervical discectomy and fusion for cervical myelopathy and radiculopathy: 10-year results from the US Nationwide Inpatient Sample

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.

Prognostic Factors Impacting Surgical Outcomes in Patients With Cervical Spondylotic Myelopathy

“…In a national database study of over 215,000 patients undergoing surgery for myelopathy and radiculopathy, presurgical depression was found in 14% of patients, with a prevalence that nearly doubled from 2005 to 2014. In patients receiving index, nonrevision surgery, depression was independently associated with prolonged length of stay, complication, and postoperative pain 20. Doi et al21 reported on the effects of depression and anxiety in patients who underwent surgery for CSM.…”

Serotonin Reuptake Inhibitor Increases Pseudarthrosis Rates in Anterior Cervical Discectomy and Fusions

“…Previous literature has suggested a depression diagnosis that leads to worse mental and physical components of patient-reported outcome measures (PROMs) following ACDF [ 9 ]. One rationale for the link between depression and inferior postoperative PROMs is a greater complication profile in this population [ 10 , 11 ]. A plausible explanation for this relationship is medication-related.…”

Brain connectivity markers in degenerative cervical myelopathy patients with depression for predicting the prognosis following decompression surgery

“…However, in the management of DCM, psychological comorbidities such as depression have been largely overlooked. Previous epidemiologic studies have revealed that the prevalence of depression in DCM patients preoperatively is about 20% ( 11 , 12 ); more importantly, psychiatric comorbidities, particularly depression, have been associated with poorer clinical outcomes in DCM patients ( 13 – 15 ). Given that depression is a significant and developing concern in DCM management, there was previously no valid, widely acknowledged approach for addressing depression in depressed DCM patients throughout the perioperative phase.…”