Elsevier

World Neurosurgery

Volume 87, March 2016, Pages 214-219
World Neurosurgery

Original Article
Pretreatment of Depression Before Cervical Spine Surgery Improves Patients' Perception of Postoperative Health Status: A Retrospective, Single Institutional Experience

https://doi.org/10.1016/j.wneu.2015.11.067Get rights and content

Background

Previous research has indicated that postoperative pain and functional outcomes are influenced by affective disorders, especially depression. The aim of this retrospective analysis is to assess whether pretreatment of depression before surgery improved patient-reported outcomes measures and overall satisfaction with care.

Methods

A total of 140 adult patients (pretreated patients: 25; control patients: 115) underwent anterior cervical discectomy and fusion at Duke University Medical Center were included in this study. Of the 140 patients, 25 patients had a known history of depression diagnosed and treated by a board-certified psychiatrist with an antidepressant at least 6 months before surgery. Enrollment criteria included available demographic, surgical, medication, and clinical outcome data. Patients completed the Neck Disability Index (NDI), Short Form-12 (SF-12), and visual analog scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes were compared between both patient cohorts.

Results

Baseline characteristics were similar between both cohorts. At baseline there were no significant differences in NDI (P = 0.11), SF-12 physical component score (PCS; P = 0.63), and neck pain VAS (P = 0.80). There were no significant differences in the incidence of nerve root injury (P = 0.00) or durotomy (P = 0.31) between the treatment and control cohorts. At 1 year postoperatively, both cohorts demonstrated similar improvement in neck pain VAS (P = 0.92), NDI (P = 0.32), SF-12 PCS (P = 0.15), and SF-12 mental component score (P = 0.38). These results were durable through 2 years. At 2 years, both the demonstrated similar improvement from baseline in neck pain VAS (P = 0.88), NDI (P = 0.43), SF-12 PCS (P = 0.28), and SF-12 mental component score (P = 0.40).

Conclusion

Our study suggests that in patients with depression, pretreatment with antidepressants before surgery significantly improves their perception and pain and functional disability.

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.

Section snippets

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.

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