Preoperative depression is associated with higher reoperation rates following anterior cervical discectomy and fusion: a multidimensional evaluation in the post–COVID-19 era

Unlike prior ACDF studies, which largely evaluated limited endpoints or smaller cohorts, this study employed multiple PROs alongside clinical and radiographic measures to comprehensively characterize depression's postoperative impact, in the context of rising depression rates following the COVID-19 pandemic. Preoperative depression independently predicted an approximately fourfold increased risk of reoperation and consistently worse PROs through 2 years after ACDF, despite similar radiographic correction. Routine preoperative mental-health screening and targeted perioperative interventions, such as expectation setting, adherence support, and activity counseling, may improve outcomes for this high-risk population.