Markers of preoperative depression and anxiety as predictors of increased short-term healthcare utilization after lumbar fusion surgery.

Abstract

Depression and anxiety affect 10%-20% of the population, are leading causes of nonfatal disease, and are underdiagnosed globally. Mental health can play a significant role in surgical outcomes, including treatment of degenerative spinal conditions. Understanding the relationships between mental health and spinal surgery outcomes is critical for optimizing perioperative care. Consecutive patients without a prior diagnosis of anxiety or depression and scheduled to undergo single-level lumbar fusion surgery were prospectively administered a quality of life survey, the EQ-5D tool (n = 1771). The EQ-5D anxiety/depression score (EAS) (subscore range 1-3) was calculated for each patient. Coarsened exact matching was used to perform a 1:1 match of patients with the highest EAS to those with the lowest EAS while controlling for patient characteristics known to impact outcomes. Primary outcomes included intraoperative durotomy, length of stay, discharge disposition, and 30- and 90-day emergency department (ED) visits, readmissions, reoperations, and mortality. After exactly matching patients with an EAS of 3 and 1, an elevated risk of anxiety and depression (EAS 3, n = 85 vs EAS 1, n = 85) was associated with significantly increased duration of hospital stay (4.03 days vs 3.23 days, p < 0.001), nonhome discharge (OR 3.28 [95% CI 1.40-7.66], p = 0.004), 30- and 90-day readmission (OR 5.0 [1.10-22.82], p = 0.021 and OR 3.66 [1.02-13.14], p = 0.033, respectively), and 90-day ED visits (OR 9.0 [1.14-71.03], p = 0.011). No significant differences in durotomy rates or 30- or 90-day reoperation rates existed between cohorts. Risk of undiagnosed depression and anxiety, as measured by the EAS, is associated with greater odds of short-term postoperative healthcare utilization, but not rate of durotomy or reoperation. Depression and anxiety screening tools, such as the EAS, may help guide targeted risk-mitigation strategies among patients undergoing spinal fusion surgery.