Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion

Abstract

Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis.Methods: Patients undergoing 1-to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart. Patients were separated into 3 groups: no depression or anxiety (NDA), depression or anxiety alone (DOA), and combined depression and anxiety (DAA). Absolute PROMs, recovery ratios, and the percentage of patients achieving minimal clinically important difference (% MCID) between groups were compared using univariate and multivariate analysis.Results: Of the 391 patients included in the cohort, 323 (82.6%) were in the NDA group, 37 (9.5%) in the DOA group, and 31 (7.9%) in the DAA group. Patients in the DAA group had significantly worse outcome scores before and after surgery with respect to Short Form-12 mental component score (MCS-12) and Oswestry Disability Index (ODI) scores (P ,.001); however, the change in PROMs, recovery ratio, % MCID were not found to be significantly different between groups. Using multivariate analysis, the DAA group was found to be an independent predictor of worse improvement in MCS-12 and ODI scores (P ¼ .026 and P ¼ .001, respectively).Conclusions: Patients with combined anxiety and depression fared worse with respect to disability before and after surgery compared to patients with a single diagnosis or no mental health diagnosis; however, there were no significant differences in recovery ratio or % MCID.Level of Evidence: 3. Clinical Relevance: Combined anxiety and depression may predict less improvement in MCS-12 and ODI after lumbar arthrodesis compared with single or no mental health diagnosis.

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

“…Meanwhile, Goh et al [ 18 ] found greater attainment of MCID for PCS in the cohort with worse initial mental health. While our analysis is unique in that it focuses entirely on a WC cohort, our data are consistent with those of Goyal et al [ 19 ] and Patel et al [ 15 ], as both cohorts had similar levels of physical MCID achievement. While preoperative mental health management may be beneficial to patients with WC insurance, our analysis reveals that it may not pose significant limitations on long-term PROMs or meaningful clinical improvement.…”

“…Goh et al [ 18 ] found that patients with worse mental health had lower preoperative PROMs but attained similar outcomes from 3 months to 2 years after MIS TLIF. Meanwhile, in the first study to assess the combined effect of depression and anxiety on PROMs after lumbar fusion, Goyal et al [ 19 ] found no significant difference in terms of the change in PROMs between both groups. Similarly, this study found no statistical difference between the two cohorts (SF-12 MCS <41 and SF-12 MCS ≥41) preoperatively or postoperatively in terms of the magnitude of improvement or the mean PROMIS-PF or SF-12 PCS scores.…”

“…No differences were found throughout the later postoperative period for either physical function PROM, suggesting that there is initial difficulty in perception of recovery, but, with time, patients with mental health troubles may realize more significant physical recovery. Goyal et al [ 19 ] also found no differences in MCID attainment for physical function between both cohorts, along with Patel et al [ 15 ] who focused on analyzing the influence of SF-12 MCS among patients with isthmic spondylolisthesis. Meanwhile, Goh et al [ 18 ] found greater attainment of MCID for PCS in the cohort with worse initial mental health.…”

“…Pelton et al [ 24 ] also reported that WC status is an indicator of high rates of pain following MIS TIlF. Meanwhile, Goyal et al [ 19 ] reported that depression and anxiety had no effect on preoperative and postoperative VAS scores. Goh et al [ 18 ] found that preoperative VAS back scores were significantly higher in individuals with poorer mental health.…”

Functional outcome in operated patients of multilevel lumbar canal stenosis and use of HRQoL role in depicting the anxiety and its correlation with the pain

“…Many studies have shown that about 20-40% of the LCS patients have clinically significant depressive symptoms. [7]; and psychological factors importance can also be understandable by the fact that the unrealistic preoperative expectations regarding pain, low optimism and lesser interest in physical activity have poor postoperative clinical outcome [4,7,27,28]. Few studies have also stressed on cognitive-behavioral patient education and role of psychotherapist in improving the clinical as well as quality of life in LCS patients and surgery can be delayed in patients with moderate LCS [7,29].…”