Impact of Depression following Spinal Surgery for Metastatic Disease to Spinal Column: A Single Institutional Study

Introduction: Prior studies have demonstrated that patients with depression undergoing spinal surgery are at risk of inferior outcomes, including higher rates of complications, extended length of stay (LOS), prolonged opioid use, and increased hospital expenditures. There remains a paucity of data, however, regarding the impact of depression on outcomes among patients undergoing spinal surgery for spinal column metastases.

Methods: A retrospective cohort study was performed using the medical records of 92 adult patients undergoing surgery for metastatic spinal column tumor at a single institution between 2013 and 2020. Patients were dichotomized according to whether they had a history of depression prior to surgery. Patient demographics, comorbidities, intraoperative variables, postoperative events, and healthcare resource utilization were assessed. The primary outcomes were perioperative complication rates, LOS, discharge dispositions, and unplanned readmissions.

Results: Of 92 patients, 26 (28.3%) had a history of depression. Patients were similar in demographics including age, sex, race, and ethnicity, and non-affective comorbidities. Cancer characteristics including tumor location and primary etiology of malignancy were also similar between the cohorts. No differences in perioperative variables between the two groups was found. Postoperatively, consultation of a pain team was significantly more likely in patients with depression (Depressed: 38.5% vs. Not depressed: 12.1%, p=0.004). Postoperative complications, LOS, discharge disposition, and unplanned readmission were not significantly different between the two cohorts. On multivariate analysis, depression was not a significant predictor of extended LOS.

Conclusion : Our study demonstrates that while patients with depression were more likely to require the consultation of a pain management team postoperatively, a history of depression is not a significant predictor of inferior outcomes such as extended hospital LOS in adult patients undergoing spine surgery for metastatic disease to the spinal column. Further studies to clarify the impact of depression are warranted to improve patient outcomes and healthcare resource utilization.