Pre-op depression tied to fewer gains in QOL after spinal surgery

(HealthDay)—For patients undergoing lumbar decompression or posterior cervical fusion (PCF), preoperative depression is associated with lower improvements in postoperative quality of life (QOL), according to two studies published in the Jan. 1 issue of The Spine Journal.

In an effort to examine the impact of preoperative depression on postoperative improvement in QOL, Jacob A. Miller, from the Cleveland Clinic, and colleagues conducted a retrospective review involving patients who underwent lumbar decompression or fusion between 2008 and 2012. The researchers observed significant correlations between elevated preoperative pain and worsened depression and diminished postoperative improvement in QOL, as measured by the EuroQoL five-dimensions (EQ-5D). Greater depression, as measured by the Patient Health Questionnaire-9 (PHQ-9), and pain correlated significantly with reduced postoperative improvement exceeding the minimum clinically important difference (P < 0.0001 and P = 0.02, respectively).

Matthew D. Alvin, M.B.A., also from the Cleveland Clinic, and colleagues examined the predictive value of preoperative depression on one-year QOL in a cohort of 88 patients who underwent PCF for cervical spondylosis. The researchers found that at one year postoperatively, the PCF cohort showed significant improvement in the Pain Disability Questionnaire, the PHQ-9, and the EQ-5D. For the PHQ-9, only 11 percent of patients achieved or surpassed the minimum clinically important difference. Increasing PHQ-9 and EQ-5D preoperative scores correlated with reduced one-year improvement in health status.

"Of patients who undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared with those with less depression," Alvin and colleagues write.

Several authors from both studies disclosed financial ties to the medical device industry.

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