title: Preoperative narcotic use and its relation to depression and anxiety in patients undergoing spine surgery.
abstract: METHODS
  Prospective review of registry data at a single institution from October 2010 to June 2012.
  
  
  OBJECTIVE
  To assess whether the amount of preoperative narcotic use is associated with preoperative depression and anxiety in patients undergoing spine surgery for a structural lesion.
  
  
  BACKGROUND
  Previous work suggests that narcotic use and psychiatric comorbidities are significantly related. Among other psychological considerations, depression and anxiety may be associated with the amount of preoperative narcotic use in patients undergoing spine surgery.
  
  
  METHODS
  Five hundred eighty-three patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to daily morphine equivalent amounts. Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were also obtained at the initial preoperative visit and recorded as measures of depression and anxiety, respectively. Resistant and robust bootstrapped multivariable linear regression analysis was performed to determine the association between ZDS and MSPQ scores and preoperative narcotics, controlling for clinically important covariates. Mann-Whitney U tests examined preoperative narcotic use in patients who were categorized as depressed (ZDS ≥ 33) or anxious (MSPQ ≥ 12).
  
  
  RESULTS
  Multivariable analysis controlling for age, sex, smoking status, preoperative employment status, and prior spinal surgery demonstrated that preoperative ZDS (P = 0.006), prior spine surgery (P = 0.007), and preoperative pain (0.014) were independent risk factors for preoperative narcotic use. Preoperative MSPQ (P = 0.083) was nearly a statistically significant risk factor. Patients who were categorized as depressed or anxious on the basis of ZDS and MSPQ scores also showed higher preoperative narcotic use than those who were not (P < 0.0001).
  
  
  CONCLUSIONS
  Depression and anxiety as assessed by ZDS and MSPQ scores were significantly associated with increased preoperative narcotic use, underscoring the importance of thorough psychological and substance use evaluation in patients being evaluated for spine surgery.
authors.affiliation: *Department of Orthopaedics, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine †Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Sheyan J
authors.initials: SJ
authors.lastname: Armaghani
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Lee
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: David N
authors.initials: DN
authors.lastname: Shau
authors.forename: Harrison
authors.initials: H
authors.lastname: Kay
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000139:chemically induced; D003863:Depression / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000009:adverse effects* / Q000494:pharmacology; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013131:Spine / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics