Depression Increases Revision Surgery Odds 16x

Patients with a history of depression and/or anxiety who undergo posterior cervical decompression and fusion have a significantly more difficult, indeed up to 16x more difficult, road to recovery than other patients, a new study finds.

As a pre-existing condition, depression and anxiety increase spine surgery revision rates, this new work from the Rothman Institute concludes. The study, “Depression Increases Posterior Cervical Decompression and Fusion Revision Rates and Diminishes Neck Disability Index,” was published online on September 15, 2022 in the journal Spine.

“Mental health diagnoses are receiving increased recognition for their influence of outcomes after spine surgery. The magnitude that mental health disorders contribute to patient-reported outcomes following posterior cervical decompression and fusion requires increased awareness and understanding,” the researchers wrote.

For the retrospective cohort study, the research team investigated the ways in which depression and anxiety can affect patient-reported outcome measures after the spine surgery. The Rothman based group collected data from electronic medical records of patients who’d been treated for back pain with posterior cervical decompression and fusion during the years 2013 to 2020. All the patients in the study were treated at the Rothman Institute in Philadelphia.

Patients were then categorized by the research team into either a depression/anxiety group or a non-depression/anxiety group based on their medical history.

Of the 195 patients included in the study 60 had a prior diagnosis of depression or anxiety. These patients tended to be slightly younger (58.8 years of age vs. 63.0; p = 0.012) and almost 2-to-1 female (53.3% vs. 31.9%; p = 0.007).

And when it came to recovery after the surgery, patients with a prior diagnosis of depression or anxiety were nearly 16x more likely to require a revision surgery (11.7% vs. 0.74%; p = 0.001) and had significantly worse postoperative neck disability index (40.7 vs. 28.5; p = 0.001) and postoperative Visual Analog Scale Neck scores (3.63 vs. 2.48; p = 0.018).

Patients with a history of depression also registered a slightly worse baseline mental component (MCS-12) (42.2 vs. 48.6; p < 0.001) and postoperative MCS-12 (46.5 vs. 52.9; p = 0.002).

By contrast, patients in the non-depression/anxiety group registered an improved MCS-12 score (p = 0.002) and neck disability index (p < 0.001) postoperatively.

The research team (see below) discovered that depression and/or anxiety was an independent predictor of decreased magnitude of neck disability index improvement on regression analysis (β = 7.14; p = 0.038).

“Patients with history of depression or anxiety demonstrate less improvement in patient-reported outcomes and a higher revision rate after posterior cervical fusion, highlighting the importance of mental health on clinical outcomes after spine surgery,” they wrote.

Study authors include Gregory R. Toci, B.S., Mark J. Lambrechts, M.D., Brian A. Karamian, M.D., Shivang Bhatt, B.S., Daria Harlamova, B.S., Jose A., Canseco, M.D., Ph.D., Ian David Kaye, M.D., Barrett I. Woods, M.D., Alan S. Hilibrand, M.D., Christopher K. Kepler, M.D., M.B.A., Alexander R. Vaccaro, M.D., Ph.D., Gregory D. Schroeder, M.D., from Rothman Institute, Thomas Jefferson University in Philadelphia, PA.  Jennifer Mao, B.S., M.B.A and Jeremy Heinle, B.S., from the Philadelphia College of Osteopathic Medicine in Philadelphia also contributed to the study.