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

• Published in: PloS one Vol. 16; no. 10; p. 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: Journal Article
• Language: English
• Published: United States Public Library of Science 15-10-2021; Public Library of Science (PLoS)
• 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; China; Beijing China; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258517

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.