The impact of preoperative depression on quality of life outcomes after lumbar surgery

Abstract

Background context: Some, smaller studies have investigated the effect of preoperative depression on postoperative improvement in quality of life (QOL). However, they have not used the Patient Health Questionnaire 9 (PHQ-9) in self-reported depression.

Purpose: To assess the effect of preoperative depression as measured by the PHQ-9 on postoperative improvement in QOL.

Study design: A retrospective review at a single tertiary-care referral center.

Patient sample: Patients who underwent lumbar decompression or fusion between 2008 and 2012.

Outcomes measures: A self-reported EuroQol five-dimensions (EQ-5D) quality-adjusted life-years Index.

Methods: Quality of life data were collected using the institutional prospectively collected database of patient-reported health status measures. The EQ-5D questionnare, PDQ, and PHQ-9 were used. Linear and logistic regression analyses were performed to assess the impact of preoperative depression on QOL improvement.

Results: Elevated preoperative pain (PDQ, β=-0.0017, p=.0009) and worsened depression (PHQ-9, β=-0.0044, p=.0359) were significantly associated with diminished postoperative improvement in QOL, as measured by the EQ-5D. Furthermore, greater depression (PHQ-9, odds ratio [OR] 0.93, p<.0001) and pain (PDQ, OR 0.99, p=.02) were associated with significantly diminished postoperative improvement exceeding the minimum clinically important difference.

Conclusions: Increased preoperative pain and depression were shown to be associated with significantly reduced improvement in postoperative QOL, as measured by the EQ-5D.

Keywords: Depression; EQ-5D; Lumbar surgery; PDQ; PHQ-9; Psychosocial outcomes.