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Pre-Existing Anxiety and Depression as a Risk Factor for Increased Postoperative Healthcare Utilization in Spine
Joshua Woo1, Nicole Rivera1, Adedotun Bello1
1Duke University School of Medicine.
Objectives:
This study aims to elucidate the association between pre-existing anxiety and depression and postoperative outcomes in spine tumor patients.
Methods:
A retrospective study was performed using the national PearlDiver Mariner database for adults with an oncologic indication who underwent spine surgery between 2011 and 2023. Patients with pre-existing anxiety or depression diagnoses were propensity score-matched by age, sex, comorbidities, and geography 1:1 to controls without psychiatric diagnoses.
Results:
Seven thousand ten total spine tumor patients with pre-existing anxiety or depression diagnoses were identified and matched to controls. Among metastatic spine disease (MSD) patients, at 30 days postoperative, pre-existing anxiety was associated with more emergency (OR=1.3, 95% CI: 1.1-1.6) and outpatient (OR=1.2, 95% CI: 1.1-1.4) visits, more palliative care (OR=1.3, 95% CI: 1.1-1.5) and cognitive behavioral therapy (CBT) (OR=1.5, 95% CI: 1.1-2.2), and more opioid (OR=1.3, 95% CI: 1.1-1.5) and SSRI (OR=2.8, 95% CI: 2.1-3.7) utilization relative to nonanxiety controls. These increased odds were consistent across time points in the MSD group. Among patients with depression, similar trends were observed at all time points as with anxiety.
Conclusions:
Pre-existing anxiety and/or depression in spine tumor patients are associated with greater postoperative outpatient health care utilization, particularly in MSD patients.