Positive Preprocedure Depression Screening Is Associated With Worse Outcomes After Single-Level Posterior-Only Lumbar...

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Psychiatry

Background:

• Major depressive disorder affects 10% of US adults, often underdiagnosed in patients with degenerative spine disease and radicular pain.
• Comorbid undiagnosed depression's impact on postoperative outcomes after lumbar fusion is not well understood.
• This study examines the association between undiagnosed depression and short-term outcomes post-lumbar fusion.

Purpose of the Study:

• To assess the relationship between depression screening scores and postoperative outcomes after lumbar fusion.
• To determine if the Patient Health Questionnaire 2 (PHQ-2) can predict increased healthcare utilization post-surgery.
• To isolate the impact of depression on outcomes by controlling for confounding factors.

Main Methods:

• Prospective and retrospective review of 3225 patients undergoing single-level posterior lumbar fusion.
• Utilized the Patient Health Questionnaire 2 (PHQ-2) for depression screening.
• Employed coarsened exact matching to control for demographic and clinical variables.

Main Results:

• 9.5% of patients (306) screened positive for depression risk (PHQ-2 scores 3-6).
• High-risk patients had significantly more 90-day postoperative emergency department visits (OR = 1.93, P = .0348).
• No significant differences were found in intraoperative complications, length of stay, discharge disposition, readmissions, or reoperations.

Conclusions:

• Elevated preoperative PHQ-2 scores correlate with increased postoperative resource utilization after lumbar spinal fusion.
• The PHQ-2 can identify patients at high risk for depression pre-surgery.
• Further research is needed to develop mitigation strategies for improving outcomes and reducing resource use.