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Preoperative Narcotic Use and Its Relation to Depression and Anxiety in Patients Undergoing Spine Surgery

Armaghani, Sheyan J. MD*; Lee, Dennis S. MD*; Bible, Jesse E. MD*; Archer, Kristin R. PhD, DPT*; Shau, David N. BS*; Kay, Harrison BS*; Zhang, Chi BA*; McGirt, Matthew J. MD; Devin, Clinton J. MD*

doi: 10.1097/BRS.0000000000000011
Clinical Case Series

Study Design. Prospective review of registry data at a single institution from October 2010 to June 2012.

Objective. To assess whether the amount of preoperative narcotic use is associated with preoperative depression and anxiety in patients undergoing spine surgery for a structural lesion.

Summary of Background Data. Previous work suggests that narcotic use and psychiatric comorbidities are significantly related. Among other psychological considerations, depression and anxiety may be associated with the amount of preoperative narcotic use in patients undergoing spine surgery.

Methods. Five hundred eighty-three patients undergoing lumbar (60%), thoracolumbar (11%), or cervical spine (29%) were included. Self-reported preoperative narcotic consumption was obtained at the initial preoperative visit and converted to daily morphine equivalent amounts. Preoperative Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) scores were also obtained at the initial preoperative visit and recorded as measures of depression and anxiety, respectively. Resistant and robust bootstrapped multivariable linear regression analysis was performed to determine the association between ZDS and MSPQ scores and preoperative narcotics, controlling for clinically important covariates. Mann-Whitney U tests examined preoperative narcotic use in patients who were categorized as depressed (ZDS ≥ 33) or anxious (MSPQ ≥ 12).

Results. Multivariable analysis controlling for age, sex, smoking status, preoperative employment status, and prior spinal surgery demonstrated that preoperative ZDS (P = 0.006), prior spine surgery (P = 0.007), and preoperative pain (0.014) were independent risk factors for preoperative narcotic use. Preoperative MSPQ (P = 0.083) was nearly a statistically significant risk factor. Patients who were categorized as depressed or anxious on the basis of ZDS and MSPQ scores also showed higher preoperative narcotic use than those who were not (P < 0.0001).

Conclusion. Depression and anxiety as assessed by ZDS and MSPQ scores were significantly associated with increased preoperative narcotic use, underscoring the importance of thorough psychological and substance use evaluation in patients being evaluated for spine surgery.

Level of Evidence: 2

Chronic narcotic use is frequently seen in patients who undergo spine surgery but information on psychiatric comorbidities on these patients is poor. We prospectively evaluated 583 patients preoperatively who were undergoing spine surgery and found a significant, direct relationship between depression and anxiety with preoperative narcotic use.

*Department of Orthopaedics, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine

Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN.

Address correspondence and reprint requests to Clinton J. Devin, MD, Vanderbilt Orthopaedic Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, 1215 21st Ave S, Ste 4200, Nashville, TN 37232-8774; E-mail:

Acknowledgement date: May 28, 2013. Revision date: August 12, 2013. Acceptance: August 29, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants.

© 2013 by Lippincott Williams & Wilkins