Depression Rates After Spine Surgery

Clark C. Chen, MD, PhD, William Taylor, MD, and Joseph Ciacci, MD Comment

A study published in Mayo Clinic Proceedings revealed that patients who underwent spine surgery had an increased risk of post-operative depression relative to those who underwent other forms of major surgery or suffer from serious illnesses, including coronary artery bypass grafting (CABG) and congestive heart failure (CHF).

two stone faces amid circular waves and dark treesA study revealed that patients who underwent spine surgery had an increased risk of post-operative depression.The research team was led by Clark C. Chen, MD, PhD, Professor and Vice Chair of Academic Affairs, University of California San Diego. The investigators used a novel study design to analyze the California Office of Statewide Health Planning and Development database. The authors first identified patients without a prior history of depression who underwent spine surgery between the years of 2000 and 2010. They then identified patients with newly diagnosed depression within 5 years of undergoing spine surgery. 

For comparison, parallel analysis was performed for patients who underwent CABG, hysterectomy, or cholecystectomy, or who experienced CHF exacerbation, or chronic obstructive pulmonary disease (COPD) exacerbation. Women who underwent uncomplicated vaginal delivery served as the comparison group. In total, the study involved over a million patient records.

Among patients who underwent surgeries, the incidence of new-onset depression within 5 years of surgery was highest in the spine surgery group. Adjusted hazard ratios (HR) analysis showed that the risk of post-operative depression for patients who underwent spinal surgery was approximately two-fold higher than for patients who underwent CABG or who have COPD. The risk of post-operative depression in spine surgery patients was approximately five-fold higher than women who had uncomplicated vaginal deliveries.

Table: Incidence and risk for new-onset depression within 5 years of hospital dischargeIncidence and risk for new-onset depression within 5 years of hospital discharge.Study co-author William Taylor, MD, Professor of Neurosurgery at the University of California San Diego, noted that “the findings of an increased rate of depression after spine surgery speaks to the disabling effects of spine problems. The risk of post-operative depression can be mitigated by appropriate counseling and referrals.”

For spinal surgery patients, the risk of post-operative depression following spine surgery was highest for patients who underwent fusion surgery or multiple spinal operations.

“The management of patients who require multiple spine surgeries is particularly challenging. Spine surgeons who treat this patient population often develop long-term relationships with their patients and adopt a multidisciplinary approach in their management,” commented coauthor Joseph Ciacci, MD, Professor of Neurosurgery, University of California San Diego.

Dr. Chen concluded, “Our study suggests the psychosocial effects that major surgeries impose on patients cannot be overstated. Fundamentally, surgical intervention alters both the physical reality and the perception of self. For patients suffering from spinal disorders, this perception is casted in psyches shaped by daily confrontation with incapacitating discomfort or inconveniences or unintended physiologic consequences of surgery. Understanding this web of altered perception will allow neurosurgeons to better care for their spine patients.”

Updated on: 02/08/18
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