Original ArticlePretreatment of Depression Before Cervical Spine Surgery Improves Patients' Perception of Postoperative Health Status: A Retrospective, Single Institutional Experience
Introduction
Affective disorders, such as depression, are associated with inferior outcomes. Previous studies have demonstrated that patients with preoperative depression experience increased postoperative pain, perioperative analgesic requirements, prolonged rate of recovery, and poor long-term outcomes.1 In addition, a high preoperative anxiety state has been shown to reliably predict the persistence of psychopathology after spine surgery.
Previous studies have reported the affects of preoperative depression on postoperative outcomes. In a prospective study of 99 patients undergoing lumbar spinal stenosis surgery, Sinikallio et al.2 demonstrated that postoperative pain and disability were significantly associated with high preoperative depression levels. Furthermore, in a recent 5-year follow-up study of the same cohort, Pakarinen et al.3 demonstrated that patients with greater levels of depression have a linear correlation with greater levels of functional disability (measured by greater Oswestry disability scores). Although preoperative depression has been found to be associated with inferior outcomes after spinal surgery, to our knowledge, no prospective studies have assessed the utility of pretreatment of baseline depression before surgery. The aim of this retrospective study is to assess whether the pretreatment of depression before cervical spine surgery improves patient-reported outcomes 2 years after index surgery.
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Methods
This was a retrospective analysis of a prospectively collected database. A total of 140 adult patients (pretreated patients: 25, control patients: 115) who underwent anterior cervical discectomy and fusion (ACDF) at Duke University Medical Center were included in this study. Of the 140 patients, 25 had a known history of depression diagnosed at least 6 months before surgery by a board-certified psychiatrist. Institutional Review Board approval was obtained before initiation of the study. We
Results
A total of 140 adult patients (pretreated: n = 25 patients, control: n = 115 patients) were enrolled in this study. There was no significant difference in age between both groups (treated cohort: 55.52 ± 9.48 years vs. control cohort: 52.26 ± 13.78 years, P = 0.16). Five patients had both a diagnosis of depression and anxiety disorder. No significant differences in body mass index between both groups (treated cohort: 30.08 ± 8.64 kg/m2 vs. control cohort: 28.56 ± 6.73 kg/m2, P = 0.41) were
Discussion
In this 2-year retrospective cohort study of patients with pretreated before surgery, we demonstrate no significant difference between both cohorts in pain and functional disability 2 years after index surgery. Compared with patients in the control cohort, patients in the pretreated cohort did not have inferior long-term outcomes after an index ACDF procedure.
Preoperative depression has been associated with increased postoperative pain, functional disability, and readmission rates. In a
Conclusions
Our study suggests that in patients with depression, pretreatment with antidepressants before surgery significantly improves their perception of pain and functional disability and maybe a viable treatment strategy for patients with coexisting depression and cervical spine pathology.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.