by Elizabeth Hofheinz, M.P.H., M.Ed.
What do we know about spine fusion patients’ mental well-being after they leave the OR? Not enough, says new research.
A multispecialty team from Hospital for Special Surgery (HSS), Icahn School of Medicine at Mount Sinai, Weill Cornell Medicine (New York City), as well as Paracelsus Medical University in Salzburg, Austria, has undertaken a study to look into trends and risk factors for new-onset anxiety and depression after spine fusion. 
The retrospective database study involved 39,495 patients who underwent anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion from 2012 to 2015, culled from the Truven MarketScan database. The study, “New Onset Depression and Anxiety After Spinal Fusion Surgery: Incidence and Risk Factors,” was published in the August 15, 2020 edition of Spine.
Co-author Stavros G. Memtsoudis, M.D., Ph.D., M.B.A. is with the departments of anesthesiology and critical care medicine at Hospital for Special Surgery (HSS), New York, NY. He commented to OSN, “Mental health outcomes after surgery are often overlooked by surgeons but have been described to be a significant problem in this context. Patients after surgery experience profound disruptions in their life, have pain, suffer disturbances in their sleep and their preoperative expectations may not align with the realities experienced after surgery. All these factors impact a patient’s physical and mental wellbeing. However, data quantifying this problem and identifying potential risk factors are not widely available. That is the reason why we sought to investigate this topic on a population level.”
“Additional significant predictors of new-onset depression included comorbid paralysis, rheumatoid arthritis, weight loss, drug abuse, and sleep apnea,” wrote the authors. “Risk factors uniquely associated with new- onset anxiety included comorbid hypertension, procedures performed in the north central region of the United States, and median household income >$60,000. Significant predictors of either new-onset anxiety or depression included rheumatoid arthritis, drug abuse, and median household income >$60,000.”
“The most important finding,” said Dr. Memtsoudis, “was the fact that new onset depression and anxiety are common amongst patients undergoing spine surgery. Further, the numbers presented here are likely underestimating the true incidence. Undiagnosed and untreated anxiety and depression are likely much more common. Further the link between chronic pain and the outcome in question is important and needs to be taken into account by physicians treating patients requiring surgery of the spine. If this link is causal in nature it cannot be answered with our data source and requires further study.”
“The realization that a significant number of spine surgical patients will develop new onset depression and/or anxiety should spark a discussion on how to better screen patients, follow them after surgery and treat them if necessary. This is important as depression and anxiety are not only associated with significant morbidity but can also jeopardize surgical outcomes. The ability to return to a productive life, the ultimate purpose for undergoing surgery, may be hampered by depression and anxiety, which in my view should be considered a postoperative complication.”
“A closer look into modifiable risk factors is advisable and aspects ranging from expectation management as well as the appropriate treatment of pain will be necessary. Patients at high risk may be identified preoperatively as to undergo possible interventions and followed appropriately postoperatively.”