Depression State Correlates with Functional Recovery Following Elective Lumbar Spine Fusion

Clarke I Cady-McCrea; Hashim J F Shaikh; Sandeep Mannava; Jonathan Stone; Hamid Hassanzadeh; Addisu Mesfin; Robert W Molinari; Emmanuel N Menga; Paul T Rubery; Varun Puvanesarajah

doi:10.1016/j.wneu.2024.04.039

Depression State Correlates with Functional Recovery Following Elective Lumbar Spine Fusion

World Neurosurg. 2024 Apr 12:S1878-8750(24)00602-8. doi: 10.1016/j.wneu.2024.04.039. Online ahead of print.

Affiliations

¹ University of Rochester Medical Center, Department of Orthopaedic Surgery & Physical Performance, Rochester, New York, USA.
² University of Rochester Medical Center, Department of Neurological Surgery, Rochester, New York, USA.
³ Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, Maryland, USA.
⁴ Medstar Orthopaedic Institute at Georgetown University Hospital, Department of Orthopaedic Surgery, Washington, D.C, USA.
⁵ University of Rochester Medical Center, Department of Orthopaedic Surgery & Physical Performance, Rochester, New York, USA. Electronic address: Vpuvanesarajah@gmail.com.

PMID: 38616025
DOI: 10.1016/j.wneu.2024.04.039

Abstract

Study design: Retrospective review of single-institution cohort.

Objective: To determine how depression state impacts postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and achievement of minimum clinically important difference (MCID) following lumbar fusion. Depression has been shown to negatively impact outcomes following numerous orthopedic surgeries. Situational and major clinical depression can differentially affect postoperative outcomes.

Methods: Adult patients undergoing elective 1-3 level lumbar fusion were reviewed. Patients with a formal diagnosis of major depression were classified as "clinically depressed" whereas patients with at least "mild" PROMIS Depression scores in the absence of formal depression diagnosis were deemed "situationally depressed." ANOVA testing was used to assess differences within and between groups. Multivariate regression was used to identify features associated with the achievement of MCID.

Results: 200 patients were included. The average age was 65.9 ± 12.2 years. 75 patients (37.5%) were non-depressed, 66 patients (33.0%) were clinically depressed, and 59 patients (29.5%) were situationally depressed. Situationally depressed patients had worse preoperative PF and PI scores and were more likely to have severe symptoms (P=0.001, P=0.001). All groups improved significantly from preoperative baseline scores. All groups met MCID PF at different rates, with highest proportion of situationally depressed reaching this metric (P = 0.03). Rates of achieving MCID PI were not significantly different between groups (P=0.47). Situational depression was predictive of achieving MCID PF (P=0.002) but not MCID PI.

Conclusions: Our study investigated the relationship between depression and postoperative PROMIS scores and identified situationally depressed patients as having the worst preoperative impairment. Despite this, the situationally depressed cohort had the highest likelihood of achieving MCID PF, suggestive of a bidirectional relationship between lumbar degenerative disease and subclinical, situational depression. These findings may help guide preoperative counseling on expectations, and patient selection.

Keywords: Depression; Lumbar fusion; MCID; PROMIS.