The influence of a history of clinical depression on peri-operative outcomes in elective total shoulder arthroplasty

Mollon, Brent; Mahure, Siddharth A.; Ding, David Y.; Jd, Zuckerman; Kwon, Young W.

doi:10.1302/0301-620x.98b6.37208

Cited by 69 publications

(53 citation statements)

References 46 publications

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“…In another prospective study of 485 elderly men undergoing transurethral prostatectomy for benign prostatic hyperplasia, Tai et al 16 showed that patients with a higher Geriatric Depression Scale (GDS) score were significantly more likely to develop postoperative delirium. Similarly, in a retrospective study of 224,060 patients undergoing elective total shoulder arthroplasty between 2002 and 2012, Mollon et al 10 showed depression to be an independent risk factor for postoperative delirium. In another retrospective analysis of 91 patients (age ≥ 75 years) who underwent esophagectomy for the treatment of esophageal cancer, Yamamoto et al 20 showed that GDS score was independently associated with postoperative delirium.…”

Section: Discussionmentioning

confidence: 93%

Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Elsamadicy

Adogwa

Lydon

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEDepression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity.METHODSThe medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis.RESULTSPatient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In total, 66 patients (7.15%) had an episode of postoperative delirium, with depressed patients experiencing approximately a 2-fold higher rate of delirium (10.59% vs 5.84%). In a multivariate logistic regression analysis, depression was an independent predictor of postoperative delirium after spine surgery in spinal deformity patients (p = 0.01).CONCLUSIONSThe results of this study suggest that depression is an independent risk factor for postoperative delirium after elective spine surgery. Further studies are necessary to understand the effects of affective disorders on postoperative delirium, in hopes to better identify patients at risk.

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Section: Discussionmentioning

confidence: 93%

Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Elsamadicy

Adogwa

Lydon

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

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“…Also, these studies may in more detail inform on whether patients with diagnoses such as sleep apnea and depression that have previously associated with POD should receive focused peri-operative care (Flink et al , 2012, Roggenbach et al , 2014, Mollon et al , 2016, Nadler et al , 2017). These studies may also make clear the extent to which susceptibility to POD as defined by significant deviations in EEG alpha and beta power “norms” may be modified by targeted peri-operative management.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Plummer

Ibala

Hahm

et al. 2019

Clinical Neurophysiology

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Objective: Electroencephalogram burst-suppression during general anesthesia is associated with post-operative delirium (POD). Whether burst-suppression causes POD or merely reflects susceptibility to POD is unclear. We hypothesized decreased intraoperative alpha (8–12 Hz) and beta (13–33 Hz) power prior to the occurrence of burst-suppression in susceptible patients. Methods: We analyzed intraoperative electroencephalogram data of cardiac surgical patients undergoing cardiopulmonary bypass (CPB). We detected the incidence and duration of CPB burst-suppression with an automated burst-suppression detection algorithm. We analyzed EEG data with multi-taper spectral estimation methods. We assessed associations between patient characteristics and burst-suppression using Binomial and Zero-inflated Poisson Regression Models. Results: We found significantly decreased alpha and beta power (7.8–22.95 Hz) in the CPB burst-suppression cohort. The odds ratio for the association between point estimates for alpha and beta power (7.8–22.95 Hz) and the incidence of burst-suppression was 0.88 (95% CI: 0.79 to 0.98). The incidence rate ratio for the association between point estimates for power between the alpha and beta range and the duration of burst-suppression was 0.89 (95% CI: 0.84 to 0.93). Conclusion: Decreased intra-operative power within the alpha and beta range was associated with susceptibility to burst-suppression during CPB. Significance: This dynamic may be used to develop principled neurophysiological-based approaches to aid the preemptive identification and targeted care of POD vulnerable patients.

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“…7,16 The relationship between depression and low-back pain is well established, 7 with depressive symptomatology linked to a more than 2-fold increase in the odds of low-back pain in 1 study. 25 Despite this association, as well as the link between depression and adverse outcomes after many types of surgery, 5,21 the impact of depression on outcomes following lumbar fusion has yet to be fully characterized.…”

mentioning

confidence: 99%

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

O’Connell

Azad²,

Mittal

et al. 2018

Neurosurgical Focus

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OBJECTIVEPreoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs.METHODSA retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug–use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs.RESULTSThe authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17–1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95–0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03–1.25), revision fusions (OR 1.15, 95% CI 1.05–1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04–1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84–1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p < 0.001) and 2 (β = 0.09, p < 0.001) years postoperatively.CONCLUSIONSAlthough these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.

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The influence of a history of clinical depression on peri-operative outcomes in elective total shoulder arthroplasty

Abstract: The awareness that clinical depression is associated with increased complications following total shoulder arthroplasty provides physicians an opportunity for early intervention in this at-risk population. Cite this article: Bone Joint J 2016;98-B:818-24.

Cited by 69 publications

References 46 publications

Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Electroencephalogram dynamics during general anesthesia predict the later incidence and duration of burst-suppression during cardiopulmonary bypass

Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes

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