Impact of Preoperative 12-item Short Form Mental Composite Scores on Clinical Outcomes in Cervical Disc Replacement

Abstract

Study Design: Retrospective cohort study. Objective: We aim to examine the effects of preoperative mental health status on demographic, perioperative characteristics, and postoperative outcomes in patients undergoing cervical disc replacement (CDR). Summary of Background Data: The effect of preoperative mental health status has not been widely studied in CDR. Methods: Patients undergoing primary CDR were retrospectively collected and stratified into 2 cohorts by 12-item Short Form Survey Mental Composite Score (SF-12 MCS) ≥48.9. Patients without preoperative SF-12 MCS scores or diagnosis of infection, malignancy, or trauma were excluded. Demographic information, perioperative characteristic, and patient reported outcome measures (PROMs) were collected. Patient reported outcome measurement information system physical function (PROMIS-PF)/SF-12 Physical Component Score (PCS)/SF-12 MCS/visual analog scale (VAS) neck/VAS leg/neck disability index (NDI) were collected preoperatively and 6 weeks/12 weeks/6 months/1 year postoperatively. Results: Eighty-seven patients were included, (47 having SF-12 MCS≥48.9). For PROMs, both cohorts had significant improvement from preoperative baseline, besides SF-12 PCS/MCS at 1 year for the depressed cohort and SF-12 MCS at all time points. The non-depressed cohort demonstrated significantly higher PROMIS-PF preoperatively and at 12 weeks, SF-12 PCS at 12 weeks, SF-12 MCS at all time points, decreased VAS neck at 12 weeks and NDI preoperatively and at 12 weeks, overall minimal clinically important difference (MCID) in most patients in all PROMs besides SF-12 MCS, and higher MCID for PROMIS-PF at 12 weeks. The depressed cohort demonstrated overall MCID in most patients with PROMIS-PF/SF-12 MCS/VAS neck/NDI, and a higher MCID for 6 weeks/12 weeks/6 months postoperatively and overall SF-12 PCS. Conclusion: Whereas both cohorts demonstrated significantly improved PROMs from baseline, the non-depressed cohort demonstrated better physical function, mental health, decreased pain, and disability at various time points, whereas the depressed cohort demonstrated higher mental health MCID achievement at every time point except 1 year. These findings may be useful in managing expectations for patients undergoing cervical surgery.

Effect of Baseline Veterans RAND-12 Mental Composite Score on Postoperative Patient-Reported Outcome Measures for Cervical Disk Replacement

“…Further, rates of clinically meaningful improvement in physical function, pain, and disability outcomes were similar between cohorts. As such, the findings in this present study typically correspond with the previously mentioned studies, where worse baseline mental health prognosticates inferior postoperative clinical outcomes 3–7,15 . Of note, our study demonstrated a superior magnitude of improvement and MCID achievement for mental health outcomes in patients with worse baseline mental health, which was not reported in some of these previous studies.…”

“…As such, the findings in this present study typically correspond with the previously mentioned studies, where worse baseline mental health prognosticates inferior postoperative clinical outcomes. [3][4][5][6][7]15 Of note, our study demonstrated a superior magnitude of improvement and MCID achievement for mental health outcomes in patients with worse baseline mental health, which was not reported in some of these previous studies. However, the magnitude of postoperative improvement and MCID achievement were similar between cohorts for physical function, pain, and disability outcomes.…”

“…5 Our laboratory studied the prognostic value of preoperative SF-12 MCS scores on clinical outcomes in patients undergoing CDR and similarly demonstrated inferior postoperative clinical outcomes in the worse preoperative mental health cohort, with greater MCID achievement in mental health outcomes. 15 In other orthopedic procedures utilizing the VR-12 MCS, worse baseline VR-12 MCS scores were predictive of prolonged length of stay, non-home discharge, and lower likelihood to achieve substantial clinical benefit and patient-acceptable symptom state. 6,7 Overall, these findings indicate that worse baseline mental health prognosticates inferior postoperative clinical outcomes.…”