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Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database

Published:November 08, 2016DOI:



      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.

      Patients and 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.


      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.


      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.

      Abbreviations and Acronyms:

      CABG (coronary artery bypass grafting), CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), HR (hazard ratio), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), OSHPD (Office of Statewide Health Planning and Development)
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        • O'Hara M.W.
        • Ghoneim M.M.
        • Hinrichs J.V.
        • Mehta M.P.
        • Wright E.J.
        Psychological consequences of surgery.
        Psychosom Med. 1989; 51: 356-370
        • Freedland K.E.
        • Rich M.W.
        • Skala J.A.
        • Carney R.M.
        • Dávila-Román V.G.
        • Jaffe A.S.
        Prevalence of depression in hospitalized patients with congestive heart failure.
        Psychosom Med. 2003; 65: 119-128
        • Wilson I.
        Depression in the patient with COPD.
        Int J Chron Obstruct Pulmon Dis. 2006; 1: 61-64
        • McKhann G.M.
        • Borowicz L.M.
        • Goldsborough M.A.
        • Enger C.
        • Selnes O.A.
        Depression and cognitive decline after coronary artery bypass grafting.
        Lancet. 1997; 349: 1282-1284
        • Timberlake N.
        • Klinger L.
        • Smith P.
        • et al.
        Incidence and patterns of depression following coronary artery bypass graft surgery.
        J Psychosom Res. 1997; 43: 197-207
        • Chou P.H.
        • Lin C.H.
        • Cheng C.
        • et al.
        Risk of depressive disorders in women undergoing hysterectomy: a population-based follow-up study.
        J Psychiatr Res. 2015; 68: 186-191
        • Tsai M.C.
        • Chen C.H.
        • Lee H.C.
        • Lin H.C.
        • Lee C.Z.
        Increased risk of depressive disorder following cholecystectomy for gallstones.
        PLoS One. 2015; 10: e0129962
      1. Office of Statewide Health Planning and Development. Patient discharge data. Office of Statement Health Planning and Development website. Updated June 27, 2016. Accessed January 2016.

        • Kumar K.
        • Taylor R.S.
        • Jacques L.
        • et al.
        Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome.
        Pain. 2007; 132: 179-188
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Chan C.
        • Peng P.
        Failed back surgery syndrome.
        Pain Med. 2011; 12: 577-606
        • Anderson V.C.
        • Israel Z.
        Failed back surgery syndrome.
        Curr Rev Pain. 2000; 4: 105-111
        • North R.B.
        • Campbell J.N.
        • James C.S.
        • et al.
        Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation.
        Neurosurgery. 1991; 25: 685-690
        • Sullivan M.J.
        • Reesor K.
        • Mikail S.
        • Fisher R.
        The treatment of depression in chronic low back pain: review and recommendations.
        Pain. 1992; 50: 5-13
        • Deyo R.A.
        • Mirza S.K.
        The case for restraint in spinal surgery: does quality management have a role to play?.
        Eur Spine J. 2009; 18: S331-S337
        • Deyo R.A.
        • Ciol M.A.
        • Cherkin D.C.
        • Loeser J.D.
        • Bigos S.J.
        Lumbar spinal fusion: a cohort study of complications, reoperations, and resource use in the Medicare population.
        Spine (Phila Pa 1976). 1993; 18: 1463-1470
        • Klauenberg S.
        • Maier C.
        • Assion H.J.
        • et al.
        Depression and changed pain perception: hints for a central disinhibition mechanism.
        Pain. 2008; 140: 332-343
        • Bär K.J.
        • Brehm S.
        • Boettger M.K.
        • Boettger S.
        • Wagner G.
        • Sauer H.
        Pain perception in major depression depends on pain modality.
        Pain. 2005; 117: 97-103
        • Lépine J.P.
        • Briley M.
        The increasing burden of depression.
        Neuropsychiatr Dis Treat. 2011; 7: 3-7
        • Wang P.S.
        • Simon G.
        • Kessler R.C.
        The economic burden of depression and the cost-effectiveness of treatment.
        Int J Methods Psychiatr Res. 2003; 12: 22-33
        • Weinstein J.N.
        • Lurie J.D.
        • Tosteson T.D.
        • et al.
        Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort.
        JAMA. 2006; 296: 2451-2459
        • McCrone S.
        • Lenz E.
        • Tarzian A.
        • Perkins S.
        Anxiety and depression: incidence and patterns in patients after coronary artery bypass graft surgery.
        Appl Nurs Res. 2001; 14: 155-164
        • Boudrez H.
        • De Backer G.
        Psychological status and the role of coping style after coronary artery bypass graft surgery: results of a prospective study.
        Qual Life Res. 2001; 10: 37-47
        • Richards D.H.
        A post-hysterectomy syndrome.
        Lancet. 1974; 2: 983-985
        • Khastgir G.
        • Studd J.W.
        • Catalan J.
        The psychological outcome of hysterectomy.
        Gynecol Endocrinol. 2000; 14: 132-141
        • Kessler R.C.
        • McGonagle K.A.
        • Zhao S.
        • et al.
        Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey.
        Arch Gen Psychiatry. 1994; 51: 8-19
        • Nielsen III, A.C.
        • Williams T.A.
        Depression in ambulatory medical patients: prevalence by self-report questionnaire and recognition by nonpsychiatric physicians.
        Arch Gen Psychiatry. 1980; 37: 999-1004