Preoperative depression is associated with higher reoperation rates following anterior cervical discectomy and fusion: a multidimensional evaluation in the post-COVID-19 era.
Depression is highly prevalent among patients with degenerative cervical spine disease and has been linked to worse postoperative outcomes across various surgical procedures. Prior studies in anterior cervical discectomy and fusion (ACDF) have primarily focused on limited endpoints such as pain or discharge disposition and were conducted before the COVID-19 pandemic. Given the rise in depression prevalence and its multidimensional impact on functional recovery, resilience, and quality of life in the post-pandemic population, a more comprehensive evaluation of its influence on ACDF outcomes is warranted.
A retrospective review of a prospectively maintained database was performed for patients undergoing ACDF between 2020 and 2022 at a single academic institution. Patients were grouped by presence or absence of a pre-existing complete depression diagnosis that were actively being treated. Demographic, perioperative, radiographic, and multiple PROs, were collected preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Multivariate logistic and linear regression controlled for age, sex, BMI, Charlson Comorbidity Index, smoking status, surgical levels, and relevant preoperative symptoms.
Of 302 patients, 134 (44.4 %) had depression. Compared with non-depressed patients, the depression cohort had higher reoperation rates (18.7 % vs. 4.8 %, p = 0.007) Depression was associated with greater persistent arm pain at 2 years (VAS 5.92 vs. 2.67, p < 0.001) and lower PROMIS Physical (38.26 vs. 44.37, p = 0.008) and Mental (41.15 vs. 50.14, p < 0.001) scores at 1 year. No significant differences were found in cervical sagittal alignment or rates of structural complications.
Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression's postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.
A retrospective review of a prospectively maintained database was performed for patients undergoing ACDF between 2020 and 2022 at a single academic institution. Patients were grouped by presence or absence of a pre-existing complete depression diagnosis that were actively being treated. Demographic, perioperative, radiographic, and multiple PROs, were collected preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Multivariate logistic and linear regression controlled for age, sex, BMI, Charlson Comorbidity Index, smoking status, surgical levels, and relevant preoperative symptoms.
Of 302 patients, 134 (44.4 %) had depression. Compared with non-depressed patients, the depression cohort had higher reoperation rates (18.7 % vs. 4.8 %, p = 0.007) Depression was associated with greater persistent arm pain at 2 years (VAS 5.92 vs. 2.67, p < 0.001) and lower PROMIS Physical (38.26 vs. 44.37, p = 0.008) and Mental (41.15 vs. 50.14, p < 0.001) scores at 1 year. No significant differences were found in cervical sagittal alignment or rates of structural complications.
Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression's postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.
Authors
Sadh Sadh, Perez-Albela Perez-Albela, Shah Shah, Bara-Garcia Bara-Garcia, Jeng Jeng, Basques Basques
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