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Spine J. 2015 Jan 1;15(1):58-64. doi: 10.1016/j.spinee.2014.06.020. Epub 2014 Jul 4.

The impact of preoperative depression on quality of life outcomes after lumbar surgery.

Author information

1
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA.
2
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106, USA.
3
Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204, USA.
4
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA.
5
Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.

Abstract

BACKGROUND CONTEXT:

Some, smaller studies have investigated the effect of preoperative depression on postoperative improvement in quality of life (QOL). However, they have not used the Patient Health Questionnaire 9 (PHQ-9) in self-reported depression.

PURPOSE:

To assess the effect of preoperative depression as measured by the PHQ-9 on postoperative improvement in QOL.

STUDY DESIGN:

A retrospective review at a single tertiary-care referral center.

PATIENT SAMPLE:

Patients who underwent lumbar decompression or fusion between 2008 and 2012.

OUTCOMES MEASURES:

A self-reported EuroQol five-dimensions (EQ-5D) quality-adjusted life-years Index.

METHODS:

Quality of life data were collected using the institutional prospectively collected database of patient-reported health status measures. The EQ-5D questionnare, PDQ, and PHQ-9 were used. Linear and logistic regression analyses were performed to assess the impact of preoperative depression on QOL improvement.

RESULTS:

Elevated preoperative pain (PDQ, β=-0.0017, p=.0009) and worsened depression (PHQ-9, β=-0.0044, p=.0359) were significantly associated with diminished postoperative improvement in QOL, as measured by the EQ-5D. Furthermore, greater depression (PHQ-9, odds ratio [OR] 0.93, p<.0001) and pain (PDQ, OR 0.99, p=.02) were associated with significantly diminished postoperative improvement exceeding the minimum clinically important difference.

CONCLUSIONS:

Increased preoperative pain and depression were shown to be associated with significantly reduced improvement in postoperative QOL, as measured by the EQ-5D.

KEYWORDS:

Depression; EQ-5D; Lumbar surgery; PDQ; PHQ-9; Psychosocial outcomes

PMID:
25007757
DOI:
10.1016/j.spinee.2014.06.020
[Indexed for MEDLINE]

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