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  • The impact of preoperative depression on quality of life outcomes after posterior cervical fusion

    Final Number:

    Matthew D. Alvin MBA MA; Jacob A. Miller BS; Swetha J Sundar BS; Megan Lockwood BS; Daniel Lubelski; Amy S. Nowacki PhD; Judith Scheman; Manu Mathews MD; Matthew J. McGirt MD; Edward C. Benzel MD; Thomas E. Mroz MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs. To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery. Affective disorders, such as depression, are associated with worsened outcomes following lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery. Our goal was to assess the predictive value of preoperative depression and health state on 1-year quality of life outcomes after PCF.

    Methods: 88 patients who underwent PCF for cervical spondylosis were reviewed. Preoperative and 1-year postoperative health outcomes were assessed based on the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire (PHQ-9), and the EuroQol-5 Dimensions (EQ-5D) Questionnaire. Univariable and multivariable regression analyses were performed to assess for preoperative predictors of 1-year change in health status. No funding was received in support of this study and no relevant conflicts of interest were present.

    Results: Compared with preoperative health states, the PCF cohort showed statistically significant improved PDQ (87.8 vs. 73.6), PHQ-9 (7.7 vs. 6.6), and EQ-5D (0.50 vs. 0.60) scores at 1 year postoperatively. Only 10/88 (11%) of patients achieved or surpassed the minimum clinically important difference for the PHQ-9 (5). Multiple linear and logistic regression analyses showed that increasing PHQ-9 and EQ-5D preoperative scores were associated with reduced 1-year postoperative improvement in health status (EQ-5D Index).

    Conclusions: Of patients that undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared to those with less depression. Additionally, patients with better preoperative health states also attain lower 1-year QOL improvements.

    Patient Care: In order to maximize the success of surgery and reduce complications and poor outcomes, patient selection of surgical candidates is imperative. Better understanding of the preoperative predictors of postoperative outcomes will improve patient selection for these elective procedures, and enable targeted strategies for patients at higher risk.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of depression, anxiety, and other psychosocial factors on postoperative quality of life outcomes after PCF and 2) Differentiate between statistical significance and clinical significance as measured by the minimum clinically important difference (MCID).

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