Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative

Zakaria, Hesham Mostafa; Mansour, Tarek R; Telemi, Edvin; Asmaro, Karam; Macki, Mohamed; Bazydlo, Michael; Schultz, Lonni; Nerenz, David R.; Abdulhak, Muwaffak; Schwalb, Jason M.; Park, Paul; Chang, Victor

doi:10.3171/2019.6.spine1963

Cited by 18 publications

(23 citation statements)

References 39 publications

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“…The published literature demonstrates inconsistencies on the effect preoperative psychological disorders have on postoperative outcomes. While the vast majority of studies demonstrate a negative correlation between the presence of these conditions and objective and subjective outcomes, 6 , 17 , 18 , 30 - 60 large trials conflict these results. 61 - 68 Evaluating this disconcordant data may promote understanding of both current knowledge gaps and potential areas of future investigation.…”

Section: Resultsmentioning

confidence: 98%

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Jackson

Rumley

Griffith

et al. 2019

Global Spine Journal

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Study Design: Literature review. Objective: The aim of this literature review is to examine the effects of psychological disorders on postoperative complications, surgical outcomes, and long-term narcotic use. We also hope to detail the value of preoperative identification and treatment of these pathologies. Methods: A series of systematic reviews of the relevant literature examining the effects of psychological disorders and spine surgery was conducted using PubMed and Cochrane databases. Results: Combined, the database queries yielded 2275 articles for consideration. After applying screening criteria, 96 articles were selected for inclusion. Patients with underlying psychological disease have higher rates of delirium, readmission, longer hospital stays, and higher rates of nonroutine discharge following spine surgery. They also have higher rates of chronic postoperative narcotic use and may experience worse surgical outcomes. Because of these defined issues, researchers have developed multiple screening tools to help identify patients with psychological disorders preoperatively for potential treatment. Treatment of these disorders prior to surgery may significantly improve surgical outcomes. Conclusion: Patients with psychological disorders represent a unique population with respect to their higher rates of spinal pain complaints, postoperative complications, and worsened functional outcomes. However, proper identification and treatment of these conditions prior to surgery may significantly improve many outcome measures in this population. Future investigations in this field should attempt to develop and validate current strategies to identify and treat individuals with psychological disorders before surgery to further improve outcomes.

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Section: Resultsmentioning

confidence: 98%

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Jackson

Rumley

Griffith

et al. 2019

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…These results were consistent with those from several previous studies 36–41 and may be explained by a complex interplay of factors involving (a) an altered motivational state (for exercise and activity), (b) executive-type cognitive impairments, and (c) the pathophysiological state of persistent low grade elevated inflammation associated with depression 38 . Given that depression, a potentially treatable condition, is often undiagnosed and untreated in patients with low back pain, 42 future research should consider identifying patients who may benefit from preoperative psychiatric optimization to improve lumbar fusion outcomes 43 …”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Pain Intensity and Walking Disability After Lumbar Fusion

Quek

Tan

Toh

et al. 2022

Spine

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Study Design. Retrospective longitudinal study. Objective. To identify the preoperative factors associated with postoperative lumbar fusion recovery in back or leg pain, selfreported walking time, and gait speed over a 6-month period. Summary of Background Data. The demand for lumbar fusion surgeries has significantly increased over the years. Yet, some patients report persistent postsurgical pain and poor functional outcomes. Unfortunately, the associated risk factors are not well understood. Methods. The study analyzed 232 subjects with mono-or bisegmental lumbar fusion surgery who underwent standardized assessment preoperatively and at 4, 12, and 24weeks postoperatively. Preoperative variables collected were demographic, clinical, and psychological variables. Back or leg pain was measured by the Numeric Pain Rating Scale. Walking disability was measured by self-reported walking time and performance-based fast gait speed. Risk factors of pain and walking disability over time were identified using ordinal and linear mixed-effects modeling.Results. At 6 months post-surgery, 17% of patients reported having moderate or severe back/leg pain and 24% were unable to walk longer than 30 minutes. Greater preoperative selfreported leg weakness frequency and body-mass-index (BMI) were strongly associated with greater pain and walking disability. Additionally, greater preoperative depression symptoms were associated with greater back/leg pain (adjusted odds ratio ¼ 4.0) and shorter walking time (adjusted odds ratio ¼ 2.7)-but not with slower gait speed (difference ¼ 0.01 m/s). Old age and female gender were strongly associated with gait speed but not with self-reported walking time. Conclusion. A sizable proportion of patients had poor pain and walking outcomes even at 6 months post-surgery. Preoperative leg weakness and BMI were consistent risk factors and patients with greater depression symptoms may have poorer selfreported outcomes. Although requiring validation, our study has identified potentially modifiable risk factors which may give clinicians an opportunity to provide early (preoperative) and targeted intervention strategies to optimize postoperative outcomes.

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“…The association between preoperative depression and postoperative outcomes was demonstrated in previous studies ( 9 , 10 ). In a retrospective study of 8,585 patients, Zakaria et al ( 38 ) found that preoperative depression (measured using the Patient Health Questionnaire-2) predicted worse satisfaction and inability to return to work. In another retrospective study, Levin et al ( 9 ) analyzed the association between depression using the PHQ-9 and postoperative satisfaction after lumbar fusion.…”

Section: Discussionmentioning

confidence: 99%

The Charlson Comorbidity Index and depression are associated with satisfaction after short-segment lumbar fusion in patients 75 years and older

et al. 2022

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BackgroundThe rate and volume of lumbar spinal fusion (LSF) surgery performed for patients aged 75 years and older increased in recent years. The purposes of our study were to identify factors associated with postoperative dissatisfaction and evaluate the predictive value of comprehensive geriatric assessment (CGA) for dissatisfaction at 2 years after elective short-segment (one- or two- level) LSF in patients aged 75 and older.MethodsThis was a retrospective study using a prospectively collected database of consecutive patients (aged 75 and older) who underwent elective short-segment transforaminal lumbar interbody fusion surgery for degenerative diseases from June 2018 to May 2020. Preoperative CGA consisting six domains was performed for each patient 1 day before the operative day. Univariate and multivariate analyses were performed to identify factors that predict for dissatisfaction with surgical treatment. The primary outcome was patient satisfaction with LSF surgery, as measured by the North American Spine Society (NASS) satisfaction scale. Secondary outcomes included postoperative complications, the length of stay, visual analog scale (VAS), and Oswestry Disability Index.ResultsA total of 211 patients were available for a follow-up at 2 years and included in our final study cohort with a mean age of 80.0 years. A total of 175 patients (82.9%) were included in the satisfied group, and 36 patients (17.1%) were included in the not dissatisfied group. In the dissatisfied group, there was a higher incidence of postoperative complications (30.6% vs. 14.3%, p = 0.024) and greater VAS scores for lower back (4.3 ± 1.9 vs. 1.3 ± 1.4, p = 0.001) and leg (3.9 ± 2.1 vs. 0.9 ± 1.3, p = 0.001). Multivariate regression analysis revealed that patients with greater CCI score [odd ratio (OR) 2.56, 95% CI, 1.12–5.76; p = 0.030 for CCI 1 or 2 and OR 6.20, 95% CI, 1.20–28.69; p = 0.024], and depression (OR 3.34, 95% CI, 1.26–9.20; p = 0.016) were more likely to be dissatisfied compared with patients with the CCI score of 0 and without depression.ConclusionsSatisfaction after LSF in older patients (aged 75 and older) was similar to that of previously reported younger patients. Preoperative depression and higher CCI scores were independent risk factors for postoperative dissatisfaction two years after LSF surgery. These results help inform decision-making when considering LSF surgery for patients aged 75 and older.

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Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative

Cited by 18 publications

References 39 publications

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

Factors Associated with Pain Intensity and Walking Disability After Lumbar Fusion

The Charlson Comorbidity Index and depression are associated with satisfaction after short-segment lumbar fusion in patients 75 years and older

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