Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Elsamadicy, Aladine A.; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda R.; Kaakati, Rayan; Mehta, Ankit I.; Vasquez, Raul A.; Cheng, Joseph; Bagley, Carlos A.; Karikari, Isaac O.

doi:10.3171/2017.4.spine161012

Cited by 55 publications

(42 citation statements)

References 22 publications

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“…As shown in Fig. 1, 17 articles were included in our review and are summarized in Tables 1 and 2 for interventional [4,[10][11][12][13][14][15][16] and observational [6][7][8][9][17][18][19][20][21][22] studies, respectively. Only seven articles of the 17 (41.2%) were interventional studies, all of which were in the form of randomized controlled trials (RCTs).…”

Section: Resultsmentioning

confidence: 99%

“…Elsamadicy et al [7] (Apr 2017) SSRI,SNRIs, others To determine whether depression or receiving antidepressants can be independent risk factors for postoperative delirium in spine deformity patients after spinal surgery -Depression is an independent predictor of postoperative delirium after spine surgery in spinal deformity patients (p=0.01).…”

Section: Levelmentioning

confidence: 99%

“…Non-specific pain, disability, poor quality of life (QOL), and prolonged hospital stay are important determinants of postoperative patient satisfaction [6,7,13,16].…”

Section: Patient Satisfaction and Long-term Outcomesmentioning

confidence: 99%

“…In a retrospective study of 923 adult patients with spine deformity, the delirium rate was 2-fold higher for depressed patients (10.59% versus 5.84%, p=0.01). Strong correlations between postoperative delirium and poor surgical outcomes, including high complication rates, prolonged hospital stay, increased health cost, and in-hospital mortality, have been reported [7]. In a retrospective study, the outcomes 6 months after surgery in pretreated depression patients and nondepressed patients were reported to be similar [6].…”

Section: Patient Satisfaction and Long-term Outcomesmentioning

confidence: 99%

“…Furthermore, depression was found to be an independent predictor of postoperative delirium following surgery to the spine. It was concluded that postoperative delirium was a preventable cause of high cost and mortality rates in intractable cases relating to the spine [7].…”

Section: Introductionmentioning

confidence: 99%

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Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

et al. 2019

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Antidepressant drugs can be advantageous in treating psychiatric and non-psychiatric illnesses, including spinal disorders. However, spine surgeons remain unfamiliar with the advantages and disadvantages of the use of antidepressant drugs as a part of the medical management of diseases of the spine. Our review article describes a systematic method using the PubMed/Medline database with a specific set of keywords to identify such benefits and drawbacks based on 17 original relevant articles published between January 2000 and February 2018; this provides the community of spine surgeons with available cumulative evidence contained within two tables illustrating both observational (10 studies; three cross-sectional, three case-control, and four cohort studies) and interventional (seven randomized clinical trials) studies. While tricyclic antidepressants (e.g., amitriptyline) and duloxetine can be effective in the treatment of neuropathic pain caused by root compression, venlafaxine may be more appropriate for patients with spinal cord injury presenting with depression and/or nociceptive pain. Despite the potential associated consequences of a prolonged hospital stay, higher cost, and controversial reports regarding the lowering of bone mineral density in the elderly, antidepressants may improve patient satisfaction and quality of life following surgery, and reduce postoperative pain and risk of delirium. The preoperative treatment of preexisting psychiatric diseases, such as anxiety and depression, can improve outcomes for patients with spinal cord injury-related disabilities; however, a preoperative platelet function assay is advocated prior to major spine surgical procedures to protect against significant intraoperative blood loss, as serotonergic antidepressants (e.g., selective serotonin reuptake inhibitors) and bupropion can increase the likelihood of bleeding intraoperatively due to drug-induced platelet dysfunction. This comprehensive review of this evolving topic can assist spine surgeons in better understanding the benefits and risks of antidepressant drugs to optimize outcomes and avoid potential hazards in a spine surgical setting.

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Section: Resultsmentioning

confidence: 99%

Section: Levelmentioning

confidence: 99%

“…Non-specific pain, disability, poor quality of life (QOL), and prolonged hospital stay are important determinants of postoperative patient satisfaction [6,7,13,16].…”

Section: Patient Satisfaction and Long-term Outcomesmentioning

confidence: 99%

Section: Patient Satisfaction and Long-term Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

et al. 2019

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The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study

et al. 2022

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Background Depression is associated with poorer outcomes in many disease states. However, its significance in abdominal surgery is unknown. This study investigated rates of depression in emergency abdominal surgery patients and its effects on outcomes. Methods A retrospective cohort study was conducted across two UK sites and included all adult patients undergoing emergency abdominal surgery. Primary outcome was the complication rate in depressed patients, including the incidence of post-operative delirium. Secondary outcomes included mortality, time to oral intake and analgesia. Results Two hundred and ten patients were identified. The commonest indication for surgery was appendicitis (53.3%) followed by small bowel obstruction (9.5%). There was a 17% ( n = 36) incidence of depression amongst patients, most of whom ( n = 26, 72.2%) were taking antidepressants. Depression was associated with male sex (M:F 27:9 p = 0.003), higher median BMI (28 vs. 25 p = 0.013 ) and previous surgery (47.2% vs. 28.7% p = 0.032 ). Despite a higher incidence of post-operative delirium, increased time to oral analgesia and greater 30-day readmission rates in the depression cohort, multivariate analyses showed depression was not a significant independent predictor of these (OR 2.181, 95%CI 0.310–15.344; p = 0.433, OR 0.07, 95%CI 0.499–1.408; p = 0.348 and OR 1.367, 95%CI 0.102–18.34, respectively). Complication and mortality rates between depressed and non-depressed individuals were similar. Conclusion Significant numbers of patients undergoing emergency abdominal surgery have depression, but this did not adversely affect post-operative outcomes. The study included relatively small numbers of participants undergoing procedures with straightforward recovery. Larger population studies are therefore required and should focus on investigating the association between major emergency surgeries with post-operative delirium and uncontrolled pain.

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A matched-control study on the impact of depressive disorders following lumbar fusion for adult spinal deformity: an analysis of a nationwide administrative database

Jamil,

Prior,

Voyvodic

et al. 2023

Eur J Orthop Surg Traumatol

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Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery

Cited by 55 publications

References 22 publications

Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study

A matched-control study on the impact of depressive disorders following lumbar fusion for adult spinal deformity: an analysis of a nationwide administrative database

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