Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY.
Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Spine (Phila Pa 1976). 2020 Aug 15;45(16):1161-1169. doi: 10.1097/BRS.0000000000003467.
Retrospective database study.
We sought to investigate trends and risk factors for new-onset anxiety and/or depression within 6 months after elective spine surgery.
Surgery represents a stressful experience associated with a number of physiological and psychological consequences. A subset of patients develop clinically significant symptoms of new-onset anxiety or depression. However, the incidence of and risk factors for these adverse outcomes after spine surgery remain ill-defined.
We performed a retrospective analysis including anterior cervical discectomy and fusion and posterior lumbar fusion cases from 2012 to 2015, utilizing the Truven MarketScan database. Primary outcomes were new-onset depression, new-onset anxiety, and new-onset depression and/or anxiety after surgery. Potential risk factors included patient demographics, comorbidities, hospital and procedural characteristics as well as perioperative opioid regimens. Multivariable logistic regression models measured associations between risk factors and outcomes. Odds ratios (OR) were reported and results with P < 0.0167 were considered statistically significant.
Among 39,495 unique patients, overall incidence of new-onset depression and anxiety was 6% and 11.2%, respectively. In adjusted analyses, significant risk factors across all three outcomes included chronic opioid use (ORs ranging from 1.31 to 2.93; P < 0.01), female sex (ORs ranging from 1.25 to 1.67; P < 0.01), longer length of stay (ORs ranging from 1.05 to 1.08; P < 0.01), and readmission within 6 months of surgery (OR ranging from 1.31 to 1.68; P < 0.01).
We identified several risk factors contributing to increased odds of new-onset depression and/or anxiety after spine fusion surgery. These data may aid the implementation of preventative measures among identified high-risk patients.
回顾性数据库研究。
我们旨在研究择期脊柱手术后 6 个月内新发焦虑和/或抑郁的趋势和危险因素。
手术代表了一种具有许多生理和心理后果的应激体验。一部分患者会出现新的明显的焦虑或抑郁症状。然而，脊柱手术后出现这些不良后果的发生率和危险因素仍不清楚。
我们进行了一项回顾性分析，纳入了 2012 年至 2015 年接受前路颈椎间盘切除术和融合术以及后路腰椎融合术的患者，使用了 Truven MarketScan 数据库。主要结局是手术后新发抑郁、新发焦虑和新发抑郁和/或焦虑。潜在的危险因素包括患者人口统计学特征、合并症、医院和手术特征以及围手术期阿片类药物方案。多变量逻辑回归模型测量了危险因素与结局之间的关系。报告了比值比（OR），并且 P 值小于 0.0167 的结果被认为具有统计学意义。
在 39495 名独特的患者中，新发抑郁和焦虑的总体发生率分别为 6%和 11.2%。在调整分析中，所有三种结局的显著危险因素包括慢性阿片类药物使用（OR 范围为 1.31 至 2.93；P 值小于 0.01）、女性（OR 范围为 1.25 至 1.67；P 值小于 0.01）、较长的住院时间（OR 范围为 1.05 至 1.08；P 值小于 0.01）和术后 6 个月内再入院（OR 范围为 1.31 至 1.68；P 值小于 0.01）。
我们确定了一些导致脊柱融合手术后新发抑郁和/或焦虑风险增加的危险因素。这些数据可能有助于在确定的高风险患者中实施预防措施。
3 级。
