Preoperative PHQ-2 Scoring Predicts Patient Satisfaction and Return to Work up to One-Year After Lumbar Fusion: A Two-Year Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC)
Zakaria HM, Bazydlo MS, Schultz LR, Schwalb JM, Park P, and Chang V. Preoperative PHQ-2 Scoring Predicts Patient Satisfaction and Return to Work up to One-Year After Lumbar Fusion: A Two-Year Analysis from the Michigan Spine Surgery Improvement Collaborative (MSSIC). Spine J 2019; 19(9):S186-S187.
BACKGROUND CONTEXT: While back pain is associated with depression, there are few studies assessing whether preoperative depression can affect outcomes after lumbar spine surgery. PURPOSE: We sought to identify the relationship between a positive PHQ-2, which is predictive of depression, and patient satisfaction, return to work, and achieving ODI MCID up to 2 years after lumbar fusion. STUDY DESIGN/SETTING: Prospective cohort. PATIENT SAMPLE: The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective multicenter quality improvement collaborative. Currently there are more than 26 different hospitals involved, and more than 20,000 patients receiving surgery from both neurosurgeons and orthopedic spine surgeons. OUTCOME MEASURES: Patient satisfaction, return to work, and achieving ODI MCID up to 2 years after lumbar fusion. METHODS: Multivariate logistic regression models were constructed; variables tested include age, gender, race, PMH, preoperative diagnosis (disc herniation, spondylolisthesis, etc), preoperative symptoms (axial pain, radicular pain, etc), severity of surgery, and preoperative opioid usage. Patient satisfaction was measured by the NASS patient satisfaction index. A positive PHQ-2 score is ≥3, which has a 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. RESULTS: A total of 8,585 lumbar fusion patients were analyzed. Multivariate analysis was performed. Patients with a positive PHQ-2 score were less likely to be satisfied after lumbar fusion at 90-days (OR 0.93, p<0.001), 1-year (OR 0.92, p=0.001), and 2-years (OR 0.92, p=0.028). A positive PHQ-2 was also associated with decreased likelihood of returning to work at 90-days (OR 0.76, p<0.001), 1-year (OR 0.85, p=0.001), and at 2-years (OR 0.82, p=0.031). A positive PHQ-2 was predictive of failure to achieve ODI MCID at 90-days (OR 1.07, p=0.005) but not at 1-year or 2-years after lumbar fusion. CONCLUSIONS: A multivariate analysis from a large, multicenter, prospective database on lumbar fusion patients was performed. We find that PHQ-2, which is a simple and accurate screening tool for depression, predicts and inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, then perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.