Health Care Utilization and Associated Economic Burden of Postoperative Surgical Site Infection after Spinal Surgery with Follow-Up of 24 Months

Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis

Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.

Impact of a severe complication two years after laparoscopic Roux-en-Y gastric bypass: a cohort study from the Scandinavian Obesity Surgery Registry

BACKGROUND

Although severe complications (SCs) after laparoscopic Roux-en-Y gastric bypass (LRYGB) are rare, they can be devastating for the affected patient.

OBJECTIVE

To access the impact of SCs (Clavien-Dindo ≥3b) 2 years after LRYGB by using a nationwide Swedish cohort of 48,201 primary cases between 2007 and June 2016.

SETTING

University hospital, Sweden.

METHODS

Patients with SC were matched 1:1 on age, sex, diabetic status, body mass index (BMI), and year of operation to patients without an SC. Weight loss, patient-scored quality of life (QoL), antidepressant use, proton pump inhibitors (PPI) and opioids, and in-hospital care were gathered from 3 national registers.

RESULTS

A total of 1411 (2.9%) patients suffered an SC and 16 (.03%) died. In total, 1403 patients with SC (mean age, 42 yr; female, 75%; with diabetes, 15.7%; mean BMI, 41.9 kg/m²) could be matched. Both groups had a total body weight loss of 32% at 2 years. A lower physical QoL was observed in SCs throughout the study period. Antidepressant, PPI and opioid use was higher among patients with SC, even 2 years after surgery. At this time point, a doubling of oral morphine equivalents (7.3 to 17.0 mg/d) was found in patients with SC compared with prior to surgery. The SC group required more in-hospital care after the initial 30 days (3.8 versus .9 d in the remaining part of the first year).

CONCLUSION

An SC resulted in higher antidepressant, PPI and opioid use as well as higher need for in-hospital care during the first 2 postoperative years. Affected patients should therefore receive special attention during follow up.