Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion

Abstract

Study Design. Retrospective cohort review. Objective. The objective of this study was to identify depression using the Mental Component Score (MCS-12) of the Short Form-12 (SF-12) survey and to correlate with patient outcomes. Summary of Background Data. The impact of preexisting depressive symptoms on health-care related quality of life (HRQOL) outcomes following lumbar spine fusion is not well understood. Methods. Patients undergoing lumbar fusion between one to three levels at a single center, academic hospital were retrospectively identified. Patients under the age of 18 years and those undergoing surgery for infection, trauma, tumor, or revision, and less than 1-year follow-up were excluded. Patients with depressive symptoms were identified using an existing clinical diagnosis or a score of MCS-12 less than or equal to 45.6 on the preoperative SF-12 survey. Absolute HRQOL scores, the recovery ratio (RR) and the percent of patients achieving minimum clinically important difference (MCID) between groups were compared, and a multiple linear regression analysis was performed. Results. A total of 391 patients were included in the total cohort, with 123 (31.5%) patients reporting symptoms of depression based on MCS-12 and 268 (68.5%) without these symptoms. The low MCS-12 group was found to have significantly worse preoperative Oswestry disability index (ODI), visual analogue scale back pain (VAS Back) and visual analogue scale leg pain (VAS Leg) scores, and postoperative SF-12 physical component score (PCS-12), ODI, VAS Back, and VAS Leg pain scores (P < 0.05) than the non-depressed group. Finally, multiple linear regression analysis revealed preoperative depression to be a significant predictor of worse outcomes after lumbar fusion. Conclusion. Patients with depressive symptoms, identified with an MCS-12 cutoff below 45.6, were found to have significantly greater disability in a variety of HRQOL domains at baseline and postoperative measurement, and demonstrated less improvement in all outcome domains included in the analysis compared with patients without depression. However, while the improvement was less, even the low MCS-12 cohort demonstrated statistically significant improvement in all HRQOL outcome measures after surgery. Level of Evidence: 3

The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion

“…All patients demonstrated a significant improvement in all PROMs after undergoing L4-L5 fusion (Table 2). On the basis of previously reported values, 74.8% of patients met MCID for ODI, 86.8% for PCS-12, 70.5% for VAS back, 63.4% for VAS leg, and 33.3% for MCS-12 25,27. Comparing preoperative and postoperative scores, the mean patient ODI score changed significantly from severe to moderate classification of disability 29…”

“…PROMs were retrieved using a SQL search through the institution’s recording software (OBERD, Columbia, MO). PROMs included pain as measured by the visual analog scale back (VAS back) and leg (VAS leg), health-related quality of life (HRQoL) as measured by the Short-Form 12 (SF-12) Physical Component (PCS-12) and mental component (MCS-12), and functional disability as measured by Oswestry disability index (ODI) score 25…”

Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients

“…20,21,25 This study also categorized patients into discrete groups (depressed vs. nondepressed) which reduces the true complexity of depression. However, analyzing depression based on categorical MCS cut-offs has previously been performed, 26,27 and we were unable to find any validated MCS cut-offs for analyzing depression as a continuum. We did not evaluate whether patients with depression had received or were currently undergoing treatment for their mental health, as this can affect postoperative outcomes in spine surgery.…”

Clinical Outcomes at One-year Follow-up for Patients With Surgical Site Infection After Spinal Fusion

“…The following threshold values were used to determine the proportion of patients who achieved the minimally clinically important difference (%MCID): PCS: 8.8 points, MCS: 10.1 points, ODI: 12.8 points, VAS Back: 1.2 points, and VAS Leg: 1.6 points. [24][25][26] A delta score (Δ) was calculated as preoperative scores subtracted from postoperative scores. An independent t test was utilized for continuous data to compare differences between two groups, while a paired t test was used to analyze differences within groups.…”