Objectives:

Studies have reported the detrimental effects of depression following spine surgery, however none have evaluated whether preoperative depression screening, in patients with a history of depression, is protective from adverse outcomes and lowers healthcare costs. We studied whether depression screenings/psychotherapy visits within 3 months prior to 1-2 level lumbar fusion (1-2LF) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations; 3) readmissions; and 4) healthcare costs.

Methods:

The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1-2LF. Two cohorts were 1:5 ratio matched and included those with (n=2,622) or without (n=13,058) a pre-operative depression screen/psychotherapy visit within 3 months of LF. A 90-day surveillance period was utilized to compare outcomes. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.003 were significant.

Results:

DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR: 2.71,p<0.0001). Rates of ED utilization were increased in patients without screening vs. screening (15.78% vs 4.23%; OR: 4.25,p<0.0001), despite no difference in readmissions (9.31% vs 9.53%; OR: 0.97,p=0.721). Finally, 90-day reimbursements ($51,160 vs $54,731) were significantly lower in the screened cohort (all p<0.0001).

Conclusions:

Patients who underwent a pre-operative depression screening within 3 months of lumbar fusion had decreased medical complications, ED utilizations, and lower healthcare costs. Spine surgeons may use this data to counsel their patients with depression prior to surgical intervention.