Preoperative Depression Is Associated with a Two-fold Increase in Readmission Rates Following Lumbar Spine Surgery: A Multi-center Institutional Study

Introduction: We aimed to examine postoperative outcomes in patients with preoperative depression undergoing lumbar decompression or arthrodesis for spinal spondylosis.

Methods: The multi-center Neurosurgery Enterprise Registry at the Mayo Clinic was queried for patients undergoing lumbar decompression with or without arthrodesis for spondylotic pathology between January 2019 and March 2022. Patients were divided into groups based on a preoperative diagnosis of depression. Primary outcomes of interest were length of hospital stay, non-routine discharge, and rates of reoperation and hospital readmission.

Results: The registry identified 3163 and 2787 patients undergoing lumbar decompression with and without arthrodesis during the study period, respectively. A preoperative diagnosis of depression was present in 443 (14.0%) and 481 (17.3%) patients, respectively. For patients undergoing either surgery, baseline characteristics significantly associated with a diagnosis of depression included younger age, female sex, higher BMI, alcohol abuse, complicated diabetes mellitus, hypertension, hypothyroidism, and peripheral vascular disease. In patients undergoing lumbar decompression, preoperative depression was associated with significantly higher rates of 30-day reoperation (1.8% vs. 0.6%, p< 0.01), 30-day readmission (6.5% vs. 2.7%, p< 0.01), and 90-day readmission (9.7% vs. 4.2%, p< 0.01). Similarly, in patients undergoing lumbar arthrodesis, preoperative depression was associated with significantly higher rates of non-routine discharge (21.0% vs. 15.4%, p< 0.01), 30-day readmission (5.4% vs. 3.3%, p =0.02), and 90-day readmission (8.9% vs. 6.2%, p =0.03). Multivariable analysis showed an independent association of preoperative depression with 30-day readmission (OR: 2.33 (1.34-4.05), p < 0.01) and 90-day (OR: 2.69 (1.71-4.23), p< 0.01) readmission rates following lumbar decompression, as well as with non-routine discharge (OR: 1.44 (1.06-1.96), p =0.02) and 30-day readmission rate (OR: 1.87 (1.11-3.16), p =0.02) following lumbar arthrodesis.

Conclusion : Our study observed preoperative depression as an independent risk factor of non-optimal post-operative outcomes, especially readmission rates, following lumbar decompression with or without arthrodesis for spinal spondylosis.