Does the Preoperative Depression Affect Clinical Outcomes in Adults With Following Lumbar Fusion?

Abstract

Objective: The objective of this study was to analyze depression using Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD-24), and to correlate with clinical outcomes and improvement in adults with following lumbar fusion.Summary of Background Data: Psychological factors such as depression are found to influence outcomes and improvement following spinal surgery. It is still unclear whether there are differences during screening for depression by different implementations to predict outcomes for spine surgery. Materials and Methods:Between July 2016 and May 2018, patients with degenerative lumbar disease, who underwent lumbar fusion were enrolled in this study. The patient's characteristics, preoperative BDI and HAMD-24 score, and preoperative and postoperative outcomes were collected, respectively. Depressed patients were identified by a score of BDI ≥ 15 or HAMD-24 > 20, respectively. Preoperative and postoperative outcome scores, absolute changes, and recovery ratios of disability and pain were compared within and between groups. Finally, univariate and multiple linear regression analyses was performed to reveal the relationship between preoperative depressive states and outcomes and improvement.Results: A total of 125 patients were eligible in the study, with 113 (90.4%) patients without depressive symptoms and 12 (9.6%) depressed patients by BDI, and 97 (77.6%) patients without depressive symptoms and 28 (22.4%) depressed patients by HAMD-24. Both higher BDI and HAMD-24 group was found to have significant worse preoperative and postoperative outcomes as well as less recovery ratios than the patients without depressive symptoms. Univariate and multiple linear regression analyses suggested that preoperative depression might be a potential predictor of worse surgical outcomes.Conclusions: Depressive symptoms might lead to smaller magnitude of improvement. Moreover, both preoperative BDI and HAMD-24 score was a negative predictor of postoperative outcomes and can be regarded as a candidate to screen for depression preoperatively.

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“…One study reported that 73% of patients with cancer who had major depression were not receiving any treatment, 24% were taking antidepressants, and only 5% were seeing a mental health professional [41]. This is important because depression has been shown to correlate with increased pain and disability and worse patient-reported outcomes/satisfaction after nononcologic orthopaedic surgery [4, 18, 37, 39, 46] as well lead to increases in all-cause mortality [16, 17, 31] and higher rates of suicide [23, 33, 45] in patients with cancer. One study looked at suicide rates among people with cancer and found the incidence of suicide to be 31.4 per 100,000 person-years, which is nearly twice as high as the national average of 16.7 per 100,000 person‐years [23].…”

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