Medical Student Columbia University Vagelos College of Physicians and Surgeons Columbia University, Vagelos College of Physicians and Surgeons
Introduction: Affective disorders and related comorbidities are increasingly recognized as risk factors for unfavorable surgical outcomes. Previous reviews have suggested that these disorders may have negative implications for outcomes in adult spinal surgery, and this systematic review seeks to provide an updated exploration of this topic and to compile appropriate recommendations for the clinical identification and management of these comorbidities.
Methods: A comprehensive literature search was performed using PubMed to identify studies published in the last ten years which evaluated the effects of depression, anxiety and insomnia in adult spinal surgery patients undergoing surgery for a deformity or degenerative condition. These studies were screened in accordance with PRISMA guidelines, and studies were excluded if they examined pediatric populations or were specific to trauma or oncology indications.
Results: Sixty-nine studies out of an initial 2043 met the criteria for inclusion. The analysis indicated that patients with untreated psychological issues experienced higher rates of postoperative complications, slower functional recovery, and lower satisfaction levels. Depression was found to be associated with a number of negative outcomes, including dose-dependent decrease in patient-reported quality of life and greater and more persistent levels of disability during the recovery period. Further associations with depression included infection, risk of reoperation, and vascular problems. Furthermore, it was found that pretreatment of depression with antidepressants significantly improved these findings. Anxiety was determined to have similar effects to depression, with varying estimates of strength of correlation. Because anxiety and depression are often comorbid with one another, literature is equivocal about anxiety’s unique effects.
Conclusion : Spine surgery patients experience chronic depression and anxiety at greater rates than the general population. Literature suggests that these comorbid psychological conditions have important effects on surgical complication rates and functional outcomes that may be mitigated with dedicated psychiatric intervention.
.jpg)
