OBJECTIVES:Recently, minimally invasive surgeries, such as endoscopic surgeries and robotic surgeries, have been frequently conducted instead of traditional open surgeries. Such minimally invasive procedures have been reported being less likely to cause depression and anxiety. Based on a claims database analysis, we compared the incidence of depression between before and after surgeries by type for those frequently conducted in the U.S.

METHODS:We used MarketScan Commercial Database. We analyzed patients who were insured during full of a three-year data period (2015-2017), and took any of surgery only once (defined as index) in 2016 with no surgery in both 2015 and 2017. Percentage of patients diagnosed as major depressive disorder (coded as 296.2x by ICD-9 or F32 by ICD-10) after one year of index was compared to that before one year of index by type of the surgery defined based on The Healthcare Common Procedure Coding System (HCPCS) code.

RESULTS:There were 5,903,263 patients who took any of surgeries at least once during the data period. Among 544,257 patients who took only one surgery in 2016 with no surgery in 2015 and 2017, 463,468 had HCPCS code. Eight of the top 10 most common surgeries were those using an endoscope including those for diagnostic tests. In 32 of the top 50 most common surgeries, percentage of patients diagnosed as major depression after index was significantly higher than before. Among the 32 surgeries, laparoscopy with total hysterectomy of the uterus 250 g or less showed the highest increase, from 7.8% before index to 12.6% after index, followed by hysteroscopic endometrial ablation (6.0% to 10.4%), laparoscopy with fulguration or excision of lesions (6.4% to 10.7%).

CONCLUSIONS:We found most of surgeries are suggested to be associated with incidence of depression regardless of degree of invasiveness and type of diseases and symptoms.