Aghajanian Sepehr, Shafiee Arman, Teymouri Athar Mohammad Mobin, Mohammadifard Fateme, Goodarzi Saba, Esmailpur Fatemeh, Elsamadicy Aladine A
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran.
Neuroscience Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran.
J Clin Med. 2024 May 31;13(11):3247. doi: 10.3390/jcm13113247.
The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.
包括抑郁症在内的精神障碍与侵入性干预措施之间的关系一直是近期文献中的一个争论话题。虽然这些疾病会影响生活质量和对手术结果的主观认知，但关于抑郁症与围手术期客观的医疗和手术并发症之间的关联，文献中尚未达成共识，尤其是在神经外科领域。我们全面检索了MEDLINE（PubMed）、EMBASE、PsycINFO和Cochrane图书馆，时间跨度从数据库建立至2023年11月10日，无语言限制，以查找关于抑郁症与脊柱手术患者住院时间、医疗和手术并发症以及包括再入院、再次手术和非常规出院在内的术后客观结果之间关联的文献。本系统评价共纳入26篇文章。对主要结局进行汇总分析后发现，包括谵妄（比值比：1.92）、深静脉血栓形成（比值比：3.72）、发热（比值比：6.34）、血肿形成（比值比：4.7）、低血压（比值比：4.32）、肺栓塞（比值比：3.79）、神经损伤（比值比：6.02）、手术部位感染（比值比：1.36）、尿潴留（比值比：4.63）和尿路感染（比值比：1.72）在内的几种并发症发生率在统计学上显著更高。虽然抑郁症患者的再入院率（比值比：1.35）、再次手术率（比值比：2.22）以及非常规出院率（比值比：1.72）显著更高，但住院时间与非抑郁症对照组相当。本综述结果强调，抑郁症患者接受脊柱手术时并发症显著增加且结局欠佳。虽然可能无法确立直接的因果关系，但在患者护理中关注精神方面对于提供全面医疗至关重要。
