TY - JOUR
T1 - Use of patient health questionnaire-2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion
T2 - A 2-year analysis from the Michigan Spine Surgery Improvement Collaborative
AU - Zakaria, Hesham Mostafa
AU - Mansour, Tarek R.
AU - Telemi, Edvin
AU - Asmaro, Karam
AU - MacKi, Mohamed
AU - Bazydlo, Michael
AU - Schultz, Lonni
AU - Nerenz, David R.
AU - Abdulhak, Muwaffak
AU - Schwalb, Jason M.
AU - Park, Paul
AU - Chang, Victor
N1 - Publisher Copyright:
©AANS 2019, except where prohibited by US copyright law.
PY - 2019
Y1 - 2019
N2 - OBJECTIVE The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire-2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion. METHODS Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is = 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage. RESULTS Multivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion. CONCLUSIONS A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an 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, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.
AB - OBJECTIVE The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire-2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion. METHODS Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is = 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage. RESULTS Multivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion. CONCLUSIONS A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an 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, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.
KW - Back pain
KW - Depression
KW - Disability
KW - Lumbar
KW - Patient-reported outcome measures
KW - Quality of life
KW - Return to work
KW - Spinal fusion
UR - http://www.scopus.com/inward/record.url?scp=85076403862&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85076403862&partnerID=8YFLogxK
U2 - 10.3171/2019.6.SPINE1963
DO - 10.3171/2019.6.SPINE1963
M3 - Article
C2 - 31443085
AN - SCOPUS:85076403862
SN - 1547-5654
VL - 31
SP - 794
EP - 801
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 6
ER -