Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database.
OBJECTIVE
To examine the relative incidence of newly recorded diagnosis of depression after spinal surgery as a proxy for the risk of post-spinal surgery depression.


METHODS
We used the longitudinal California Office of Statewide Health Planning and Development database (January 1, 2000, through December 31, 2010) to identify patients who underwent spinal surgery during these years. Patients with documented depression before surgery were excluded. Risk of new postoperative depression was determined via the incidence of newly recorded depression on any hospitalization subsequent to surgery. For comparison, this risk was also determined for patients hospitalized during the same time period for coronary artery bypass grafting, hysterectomy, cholecystectomy, chronic obstructive pulmonary disease, congestive heart failure exacerbation, or uncomplicated vaginal delivery.


RESULTS
Our review identified 1,078,639 patients. Relative to the uncomplicated vaginal delivery cohort, the adjusted hazard ratios (HRs) for newly recorded depression within 5 years after the admission of interest were 5.05 for spinal surgery (95% CI, 4.79-5.33), 2.33 for coronary artery bypass grafting (95% CI, 2.15-2.54), 3.04 for hysterectomy (95% CI, 2.88-3.21), 2.51 for cholecystectomy (95% CI, 2.35-2.69), 2.44 for congestive heart failure exacerbation (95% CI, 2.28-2.61), and 3.04 for chronic obstructive pulmonary disease (95% CI, 2.83-3.26). Among patients who underwent spinal surgery, this risk of postoperative depression was highest for patients who underwent fusion surgery (HR, 1.28; 95% CI, 1.22-1.36) or had undergone multiple spinal operations (HR, 1.22; 95% CI, 1.16-1.29) during the analyzed period.


CONCLUSIONS
Patients who undergo spinal surgery have a higher risk for postoperative depression than patients treated for other surgical or medical conditions known to be associated with depression.
School of Medicine, University of California, San Diego, CA.
Bayard R
BR
Wilson
School of Medicine, University of California, San Diego, CA.
Kathryn R
KR
Tringale
Department of Neurosurgery, University of California, San Diego, CA.
Brian R
BR
Hirshman
Department of Neurosurgery, University of California, San Diego, CA.
Tianzan
T
Zhou
Department of Psychiatry, University of California, San Diego, CA.
Anya
A
Umlauf
Department of Neurosurgery, University of California, San Diego, CA.
William R
WR
Taylor
Department of Neurosurgery, University of California, San Diego, CA.
Joseph D
JD
Ciacci
Department of Neurosurgery, University of California, San Diego, CA.
Bob S
BS
Carter
Department of Neurosurgery, University of California, San Diego, CA. Electronic address: clarkchen@ucsd.edu.
Clark C
CC
Chen
D000328:Adult; D002140:California / Q000453:epidemiology; D002763:Cholecystectomy / Q000523:psychology; D001026:Coronary Artery Bypass / Q000523:psychology; D016208:Databases, Factual; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000523:psychology; D006801:Humans; D007044:Hysterectomy / Q000523:psychology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D036801:Parturition / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology; D013122:Spinal Diseases / Q000523:psychology* / Q000601:surgery*; D013131:Spine / Q000601:surgery*