Nayar Gautam, Elsamadicy Aladine A, Zakare-Fagbamila Rasheedat, Farquhar Julia, Gottfried Oren N
Department of Neurological Surgery, Duke University Medical Center, Durham, NC.
Department of Neurological Surgery, Duke University Medical Center, Durham, NC.
World Neurosurg. 2017 Apr;100:69-73. doi: 10.1016/j.wneu.2016.12.098. Epub 2017 Jan 3.
Decompressive spinal surgery patients have high expectations of recovering functionally, both at work and with leisurely activities. Affective disorders, such as depression or anxiety, are increasingly prevalent in this population and are associated with poorer baseline quality-of-life measures and worse postoperative outcomes. The study examined the results of affective disorders on self-reported recovery of baseline function (RBF) following decompressive spinal surgery.
Medical records of 275 patients undergoing elective decompressive spinal surgery at a major academic institution were reviewed. There were 101 (36.7%) patients (with diagnosed anxiety or depression) in the affective disorder cohort (ADC) and 174 (63.6%) patients in the control cohort. The main outcome measure was self-reported RBF 3 months after surgery. Multivariate regression analysis was also used to determine whether affective disorders were a risk factor for poor RBF.
Baseline demographics, comorbidities, and perioperative variables between the two cohorts were similar, except for a higher proportion of females, more smokers, and longer length of stay in the ADC. On patient-reported outcome measures, the ADC had significantly decreased baseline scores and decreased improvement in scores over time. On univariate analysis, the ADC had significantly lower rates of RBF at 3 months after surgery. On regression analysis, affective disorders were an independent risk factors for poor RBF.
This study suggests that affective disorders are an independent risk factor for decreased recovery of baseline functionality after decompressive spinal surgery. Preoperatively identifying these patients could improve management of postoperative expectations and thereby improve surgical outcome.
接受减压性脊柱手术的患者对恢复工作及休闲活动功能抱有很高期望。情感障碍，如抑郁或焦虑，在这一人群中日益普遍，且与较差的基线生活质量指标及更糟的术后结果相关。本研究考察了情感障碍对减压性脊柱手术后自我报告的基线功能恢复（RBF）的影响。
回顾了一家大型学术机构中275例接受择期减压性脊柱手术患者的病历。情感障碍队列（ADC）中有101例（36.7%）患者（被诊断为焦虑或抑郁），对照组中有174例（63.6%）患者。主要结局指标是术后3个月的自我报告RBF。还采用多变量回归分析来确定情感障碍是否是RBF不佳的危险因素。
除了ADC中女性比例更高、吸烟者更多及住院时间更长外，两个队列之间的基线人口统计学特征、合并症及围手术期变量相似。在患者报告的结局指标方面，ADC的基线分数显著降低，且分数随时间的改善程度也降低。单变量分析显示，ADC在术后3个月时RBF率显著更低。回归分析表明，情感障碍是RBF不佳的独立危险因素。
本研究表明，情感障碍是减压性脊柱手术后基线功能恢复下降的独立危险因素。术前识别这些患者可改善对术后期望的管理，从而改善手术结果。
