Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Abstract

ImportanceComorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive.ObjectiveTo investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery.Data SourcesA systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023.Study SelectionIncluded studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included.Data Extraction and SynthesisAll data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity.Main Outcomes and MeasuresThe primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations.ResultsOf the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, −0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, −0.52 [95% CI, −0.62 to −0.41]; I2 = 89%; P < .001), which remained worse postoperatively (SMD, −0.52 [95% CI, −0.75 to −0.28]; I2 = 98%; P < .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance.Conclusions and RelevanceResults of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.

Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis

“…Two preceding systematic reviews have investigated the correlation between preoperative depression and the outcomes of spine surgeries, offering diverse perspectives on this intricate interconnection. One review posits that the degree of improvement is similar when comparing groups with and without depression; however, individuals with depression reported a more pronounced level of pain [ 7 ]. Notably, our research deviates by scrutinizing distinct, more objectively measurable results.…”

“…Notably, our research deviates by scrutinizing distinct, more objectively measurable results. The review conducted by Javeed et al asserts a direct link between preoperative depression and unfavorable quality of life and disability outcomes [ 7 ]. Mollon et al [ 43 ] and Häuser et al [ 44 ] independently validated that preoperative depression significantly associates with increased rates of postoperative complications.…”

“…Understanding the influence of depression on the clinical outcomes of spine surgeries is crucial since a deeper understanding of this relationship can inform the development of targeted perioperative strategies, with the potential to reduce complications and enhance overall patient care and satisfaction. Although the expected correlation of preoperative depression with postoperative self-reported quality of life and patient disability outcomes in spinal surgeries have been recently investigated [ 7 ], the impact of depression on medical and surgical outcomes is not thoroughly understood and is further explored in a quantitative manner in this review.…”