The Impact of Depression and Anxiety on Perioperative Outcomes and Patient-Reported Outcomes Measurement Information System Physical Function After Thoracolumbar Surgery

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Figure 1
Average patient-reported outcomes measurement information system physical function score over time in patients undergoing decompression surgery. Postop, postoperative; Preop, preoperative.
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Figure 2
Average patient-reported outcomes measurement information system physical function score over time: patients undergoing fusion surgery. Postop, postoperative; Preop, preoperative.

Table 1

Patient demographics and surgeries performed.

Variable	No Depression or Anxiety (n = 391)	Depression or Anxiety (n = 205)	P Value
Age	61.2 ± 14.3	61.7 ± 13.3	0.682
Female sex	154 (39.4)	135 (65.9)	<0.001
Body mass index	30.1 ± 5.9	31.4 ± 6.5	0.020
Non-white race^{^a}	63 (16.8)	13 (6.6)	0.001
Current smoker	32 (8.2)	23 (11.2)	0.224
Former smoker	132 (33.8)	82 (40.0)	0.131
American Society of Anesthesiologists score ≥3	163 (41.7)	112 (54.6)	0.003
Surgery performed			0.042
Decompression	236 (60.4)	106 (51.7)
Fusion	155 (39.6)	99 (48.3)
Fusion type
Posterior lumbar interbody fusion/transforaminal lumbar interbody fusion	81 (52.3)	48 (48.5)	0.557
Posterolateral fusion	63 (40.6)	41 (41.4)	0.903
Lateral lumbar interbody fusion/extreme lateral interbody fusion	11 (7.1)	10 (10.1)	0.396
Operative levels			0.088
1–2 Levels	324 (82.9)	158 (77.1)
3+ Levels	67 (17.1)	47 (22.9)
Surgery included thoracic levels	23 (5.9)	18 (8.8)	0.184

Table 2

Depression or anxiety patient cohort details (n = 205).

Characteristic	N (%)
Depression only	65 (31.7)
Anxiety only	66 (32.3)
Depression and anxiety	74 (36.1)
On antidepressant medication	126 (61.5)
Serotonin and norepinephrine reuptake inhibitor	29 (14.1)
Selective serotonin reuptake inhibitor	74 (36.1)
Other	29 (14.1)
Other concomitant psychiatric conditions
Bipolar disorder	8 (3.9)
Schizophrenia	0 (0.0)
Other	0 (0.0)

Table 3

Patient outcomes by depression/anxiety status and procedure type.

Outcome Measure	Decompression			Fusion
Outcome Measure	No Depression or Anxiety (n = 236)	Depression or Anxiety (n = 106)	P Value	No Depression or Anxiety (n = 155)	Depression or Anxiety (n = 99)	P Value
Length of stay, d	0.48 ± 1.15	0.50 ± 1.85	0.898	2.62 ± 2.29	3.01 ± 2.39	0.194
Home discharge	235 (99.6)	105 (99.1)	0.524^{^a}	139 (89.7)	85 (85.9)	0.358
90-d emergency department return	23 (9.7)	20 (18.9)	0.019	31 (20.0)	17 (17.2)	0.574
90-d readmission	6 (2.5)	8 (7.5)	0.031	20 (12.9)	12 (12.1)	0.855
1-y complication	2 (0.8)	6 (5.7)	0.012^{^a}	9 (5.8)	4 (4.0)	0.533
Hematoma	2 (0.8)	2 (1.9)	0.591^{^a}	4 (2.6)	1 (1.0)	0.651^{^a}
Wound dehiscence or SSI	0 (0.0)	2 (1.9)	0.095^{^a}	1 (0.6)	1 (1.0)	1.000^{^a}
Pulmonary embolism or DVT	0 (0.0)	1 (0.9)	0.310^{^a}	1 (0.6)	0 (0.0)	1.000^{^a}
Compression fracture or broken hardware	0 (0.0)	1 (0.9)	0.310^{^a}	1 (0.6)	1 (1.0)	1.000^{^a}
Other medical	0 (0.0)	0 (0.0)	N/A	2 (1.3)	1 (1.0)	1.000^{^a}
1-y residual radiculopathy	13 (5.5)	10 (9.4)	0.180	3 (1.9)	3 (3.0)	0.575
1-y revision surgery	13 (5.5)	9 (8.5)	0.299	8 (5.2)	4 (4.0)	0.770^{^a}
Revision fusion	6 (2.5)	4 (3.8)	0.507^{^a}	4 (2.6)	4 (4.0)	0.715^{^a}
Follow-up, mo	7.2 ± 7.2	7.5 ± 8.3	0.712	10.6 ± 7.0	10.6 ± 7.7	0.953

Table 4

Patient outcomes by antidepressant usage and procedure type in patients with depression or anxiety.

Outcome Measure	Decompression			Fusion
Outcome Measure	Antidepressant Use (n = 43)	No Antidepressant Use (n = 63)	P Value	Antidepressant Use (n = 36)	No Antidepressant Use (n = 63)	P Value
Length of stay, d	0.44 ± 2.00	0.54 ± 1.76	0.791	3.56 ± 3.18	2.70 ± 1.75	0.142
Home discharge	42 (97.7)	63 (100.0)	0.406^{^a}	30 (83.3)	55 (87.3)	0.586
90-d emergency department return	7 (16.3)	13 (20.6)	0.574	9 (25.0)	8 (12.7)	0.118
90-d readmission	2 (4.7)	6 (9.5)	0.469^{^a}	6 (16.7)	6 (9.5)	0.345^{^a}
1-y complication	0 (0.0)	6 (9.5)	0.079^{^a}	3 (8.3)	1 (1.6)	0.135^{^a}
1-y residual radiculopathy	4 (9.3)	6 (9.5)	1.000^{^a}	2 (5.6)	1 (1.6)	0.299^{^a}
1-y revision surgery	4 (9.3)	5 (7.9)	1.000^{^a}	3 (8.3)	1 (1.6)	0.135^{^a}
Follow-up, mo	8.4 ± 8.5	7.0 ± 8.2	0.408	12.6 ± 8.2	9.5 ± 7.2	0.053

Table 5

Risk-adjusted effect of depression or anxiety on maximum patient-reported outcomes measurement information system physical function improvement.

Variable	Unadjusted β	95% CI	P Value
Body mass index	−0.028	−0.234 to 0.179	0.793
Female sex	0.422	−2.218 to 3.062	0.753
Non-white race	2.547	−1.346 to 6.440	0.199
American Society of Anesthesiologists score ≥3	−0.892	−3.599 to 1.814	0.517
Fusion surgery	0.383	−2.173 to 2.940	0.768
Depression or anxiety	1.003	−1.744 to 3.750	0.473