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

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...

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Bibliographic Details
Published in:PloS one 2021-10, Vol.16 (10), p.e0258517-e0258517
Main Authors: Chen, Jiang, Li, Jin-Yu, Tian, Gui-Hua, Qiu, Rui-Jin, Zhao, Xue-Qian, Di, Xue-Shi, Yuan, Qiao-Mei, Long, Shui-Wen, Ran, Yu, Jia, Yu-Song, Shang, Hong-Cai
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anxiety
Back surgery
Biology and Life Sciences
Bone surgery
Care and treatment
Central nervous system diseases
Chronic pain
Comorbidity
Complications
Complications and side effects
Databases, Factual
Delirium
Depression - etiology
Depression, Mental
Disease
Diskectomy - adverse effects
Dysphagia
Education
Female
Health risks
Hospital Costs
Humans
Inpatients - psychology
Internal medicine
Intervertebral discs
Joint surgery
Laboratories
Length of Stay
Male
Medicine
Medicine and Health Sciences
Mental depression
Mental disorders
Mental health
Middle Aged
Odds Ratio
Orthopedics
Pain
Pain, Postoperative
Pain, Postoperative - etiology
Patients
Population
Postoperative Complications
Radiculopathy - pathology
Radiculopathy - surgery
Retrospective Studies
Sepsis
Social Sciences
Spinal cord
Spinal Cord Diseases - pathology
Spinal Cord Diseases - surgery
Spinal Fusion - adverse effects
Spine
Spine (cervical)
Surgery
Surgical outcomes
Young Adult
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Summary: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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0258517