Elsamadicy Aladine A, Adogwa Owoicho, Lydon Emily, Sergesketter Amanda, Kaakati Rayan, Mehta Ankit I, Vasquez Raul A, Cheng Joseph, Bagley Carlos A, Karikari Isaac O
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
Department of Neurosurgery, Rush University Medical Center, Chicago.
J Neurosurg Spine. 2017 Aug;27(2):209-214. doi: 10.3171/2017.4.SPINE161012. Epub 2017 Jun 2.
OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In total, 66 patients (7.15%) had an episode of postoperative delirium, with depressed patients experiencing approximately a 2-fold higher rate of delirium (10.59% vs 5.84%). In a multivariate logistic regression analysis, depression was an independent predictor of postoperative delirium after spine surgery in spinal deformity patients (p = 0.01). CONCLUSIONS The results of this study suggest that depression is an independent risk factor for postoperative delirium after elective spine surgery. Further studies are necessary to understand the effects of affective disorders on postoperative delirium, in hopes to better identify patients at risk.
目的 抑郁症是美国最常见的情感障碍，脊柱畸形患者患抑郁症的风险更高。术后谵妄与包括发病率和死亡率在内的较差手术结果相关。脊柱手术患者中抑郁症与术后谵妄之间的关系相对未知。本研究的目的是确定抑郁症是否是接受减压和融合治疗脊柱畸形患者发生术后谵妄的独立危险因素。
方法 回顾了2005年至2015年在一家主要学术机构接受择期脊柱手术的923例成年患者（年龄≥18岁）的病历。在这些患者中，255例（27.6%）患者被经委员会认证的精神科医生诊断为患有抑郁症，构成抑郁症组；其余668例患者构成非抑郁症组。收集每位患者的人口统计学、合并症以及术中和术后并发症发生率，并在组间进行比较。本研究调查的主要结局是根据DSM-V标准，术后初次住院期间的术后谵妄发生率。通过多因素逻辑回归分析评估抑郁症与术后谵妄发生率之间的关联。
结果 两组患者除抑郁症外的人口统计学和合并症相似。在抑郁症组中，85.1%的患者在手术前服用抗抑郁药。除谵妄外，术中变量和并发症发生率在组间无显著差异。队列之间的术后并发症发生率也相似，包括尿路感染、发热、深部和浅表手术部位感染、肺栓塞、深静脉血栓形成、尿潴留以及转入重症监护病房的患者比例。共有66例患者（7.15%）发生术后谵妄，抑郁症患者的谵妄发生率约高出2倍（10.59%对5.84%）。在多因素逻辑回归分析中，抑郁症是脊柱畸形患者脊柱手术后术后谵妄的独立预测因素（p = 0.01）。
结论 本研究结果表明，抑郁症是择期脊柱手术后术后谵妄的独立危险因素。有必要进行进一步研究以了解情感障碍对术后谵妄的影响，以期更好地识别有风险的患者。
