1Stanford University School of Medicine, Stanford, California.
Departments of2Neurosurgery and.
Neurosurg Focus. 2018 Jan;44(1):E5. doi: 10.3171/2017.10.FOCUS17563.
OBJECTIVE Preoperative depression has been linked to a variety of adverse outcomes following lumbar fusion, including increased pain, disability, and 30-day readmission rates. The goal of the present study was to determine whether preoperative depression is associated with increased narcotic use following lumbar fusion. Moreover, the authors examined the association between preoperative depression and a variety of secondary quality indicator and economic outcomes, including complications, 30-day readmissions, revision surgeries, likelihood of discharge home, and 1- and 2-year costs. METHODS A retrospective analysis was conducted using a national longitudinal administrative database (MarketScan) containing diagnostic and reimbursement data on patients with a variety of private insurance providers and Medicare for the period from 2007 to 2014. Multivariable logistic and negative binomial regressions were performed to assess the relationship between preoperative depression and the primary postoperative opioid use outcomes while controlling for demographic, comorbidity, and preoperative prescription drug-use variables. Logistic and log-linear regressions were also used to evaluate the association between depression and the secondary outcomes of complications, 30-day readmissions, revisions, likelihood of discharge home, and 1- and 2-year costs. RESULTS The authors identified 60,597 patients who had undergone lumbar fusion and met the study inclusion criteria, 4985 of whom also had a preoperative diagnosis of depression and 21,905 of whom had a diagnosis of spondylolisthesis at the time of surgery. A preoperative depression diagnosis was associated with increased cumulative opioid use (β = 0.25, p < 0.001), an increased risk of chronic use (OR 1.28, 95% CI 1.17-1.40), and a decreased probability of opioid cessation (OR 0.96, 95% CI 0.95-0.98) following lumbar fusion. In terms of secondary outcomes, preoperative depression was also associated with a slightly increased risk of complications (OR 1.14, 95% CI 1.03-1.25), revision fusions (OR 1.15, 95% CI 1.05-1.26), and 30-day readmissions (OR 1.19, 95% CI 1.04-1.36), although it was not significantly associated with the probability of discharge to home (OR 0.92, 95% CI 0.84-1.01). Preoperative depression also resulted in increased costs at 1 (β = 0.06, p < 0.001) and 2 (β = 0.09, p < 0.001) years postoperatively. CONCLUSIONS Although these findings must be interpreted in the context of the limitations inherent to retrospective studies utilizing administrative data, they provide additional evidence for the link between a preoperative diagnosis of depression and adverse outcomes, particularly increased opioid use, following lumbar fusion.
术前抑郁与腰椎融合术后多种不良结局相关，包括疼痛加重、残疾和 30 天再入院率增加。本研究旨在确定术前抑郁是否与腰椎融合术后阿片类药物使用增加有关。此外，作者还研究了术前抑郁与多种次要质量指标和经济结局之间的关系，包括并发症、30 天再入院、翻修手术、出院回家的可能性以及 1 年和 2 年的成本。
使用全国纵向行政数据库（MarketScan）进行回顾性分析，该数据库包含各种私人保险公司和医疗保险患者的诊断和报销数据，时间范围为 2007 年至 2014 年。采用多变量逻辑和负二项回归来评估术前抑郁与术后主要阿片类药物使用结局之间的关系，同时控制人口统计学、合并症和术前处方药使用等变量。还使用逻辑和对数线性回归来评估抑郁与并发症、30 天再入院、翻修、出院回家的可能性以及 1 年和 2 年成本等次要结局之间的关系。
作者确定了 60597 名接受过腰椎融合术且符合研究纳入标准的患者，其中 4985 名患者术前诊断为抑郁，21905 名患者在手术时诊断为腰椎滑脱。术前抑郁诊断与累积阿片类药物使用增加（β=0.25，p<0.001）、慢性使用风险增加（OR 1.28，95%CI 1.17-1.40）和阿片类药物停药可能性降低（OR 0.96，95%CI 0.95-0.98）相关。就次要结局而言，术前抑郁与并发症（OR 1.14，95%CI 1.03-1.25）、翻修融合术（OR 1.15，95%CI 1.05-1.26）和 30 天再入院（OR 1.19，95%CI 1.04-1.36）的风险略增加有关，尽管与出院回家的可能性（OR 0.92，95%CI 0.84-1.01）无关。术前抑郁还导致术后 1 年（β=0.06，p<0.001）和 2 年（β=0.09，p<0.001）的成本增加。
尽管这些发现必须结合利用行政数据进行回顾性研究固有的局限性进行解释，但它们为术前抑郁诊断与腰椎融合术后不良结局之间的关联提供了更多证据，特别是阿片类药物使用增加。
