Impact of Preoperative Depression on Postoperative Dysphagia After Cervical Surgery

Introduction: This study examines the extent to which preoperative depression predicts dysphagia after cervical spine surgery.

Methods: A prospectively collected multi-institutional quality registry was retrospectively reviewed. Patients undergoing cervical surgery were categorized based on preoperative depression, and correlations with preoperative and postoperative Eating Assessment Tool-10 (EAT-10) dysphagia questionnaire scores were assessed. Mixed-effects logistic regressions were performed to assess the impact of preoperative depression on the incidence of dysphagia.

Results: Out of 2,002 patients meeting inclusion criteria, 524 (26%) reported having preoperative depression. Depression was associated with a higher incidence of dysphagia at baseline (25% vs. 11%, p< 0.001), 1 month (61% vs. 54%, p=0.041), 3 months (36% vs. 26%, p< 0.001) and 12 months (36% vs. 22%, p< 0.001). Including baseline dysphagia as a fixed effect, multivariable analysis revealed that depression is not a significant independent predictor of postoperative dysphagia at 1 month (OR=1.08, p=0.7), 3 months (OR=1.10, p=0.6), or 12 months (OR=1.28, p=0.2). Patients with depression and no baseline dysphagia (395 out of 524) were significantly more likely to report new dysphagia at 12 months (26% vs. 18%, p=0.009) but not at 1 month (54% vs. 51%, p=0.6) or 3 months (27% vs. 23%, p=0.085). The average change in EAT-10 scores between baseline and 12 months was significantly worse in patients with preoperative depression and no baseline dysphagia (2.553±5.056 vs. 1.644±4.097, p< 0.001). Multivariable analysis revealed that depression is not a significant independent predictor of new postoperative dysphagia at 1 month (OR=1.05, p=0.8), 3 months (OR=1.18, p=0.4), or 12 months (OR=1.16, p=0.5).

Conclusion : Although preoperative depression is not an independent predictor of postoperative dysphagia, patients with preoperative depression report dysphagia more often at baseline, 1, 3, and 12 months after cervical surgery. Preoperative depression may be valuable as a risk factor for developing dysphagia after cervical surgery due to its association with other comorbidities and risk factors.