Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression

Article Figures & Data

Table 1

Patient demographics by PHQ-9 score.

Characteristic	Total (n = 351)	PHQ-9<5 (n = 186)	PHQ-95–10 (n = 94)	PHQ-9>10 (n = 71)	P value^b
Age, y, mean ± SD	46.8 ± 14.3	48.6 ± 14.9	46.4 ± 13.6	42.5 ± 12.4	0.008
Gender					0.605
Female	29.6% (104)	27.4% (51)	33.0% (31)	31.0% (22)
Male	70.4% (247)	72.6% (135)	67.0% (63)	69.0% (49)
Body mass index					0.041
Nonobese (<30 kg/m²)	57.0% (200)	62.9% (117)	53.2% (50)	46.5% (33)
Obese (≥30 kg/m²)	43.0% (151)	37.1% (69)	46.8% (44)	53.5% (71)
Smoking status					0.085
Nonsmoker	88.9% (312)	91.4% (170)	89.4% (84)	81.7% (58)
Smoker	11.1% (39)	8.6% (16)	10.5% (10)	18.3% (13)
Insurance coverage					0.334
Private or workers compensation	97.4% (338)	96.2% (179)	98.9% (92)	98.5% (67)
Medicare/Medicaid	2.6% (9)	3.8% (7)	1.1% (1)	1.5% (1)
Ageless CCI, mean ± SD	0.63 ± 0.9	0.65 ± 0.9	0.69 ± 0.9	0.51 ± 0.8	0.432
Duration of symptoms, mo, mean ± SD	34.0 ± 57.0	30.0 ± 64.4	20.0 ± 59.6	16.4 ± 31.2	0.144
Preoperative diagnosesa
Chronic obstructive pulmonary disease	0.8% (1)	1.8% (1)	1.8% (1)	0% (0)	0.
Myocardial infarction	2.3% (8)	2.7% (5)	1.1% (1)	2.8% (2)	0.652
Diabetes	5.4% (21)	3.2% (6)	12.8% (12)	4.2% (3)	0.005
Congestive heart failure	0.6% (2)	0.5% (1)	1.1% (1)	0% (0)	0.665
Hypertension	23.4% (82)	23.1% (43)	29.8% (28)	15.5% (11)	0.099
Neurologic disease	0.6% (2)	1.1% (2)	0.0% (0)	0% (0)	0.410
Arthritis	8.6% (30)	9.7% (18)	6.4% (6)	8.5% (6)	0.648
Renal failure	0.3% (1)	0.5% (1)	0.0% (0)	0.0% (0)	0.648
Malignancy	4.6% (16)	7.0% (13)	3.2% (3)	0.0 % (0)	0.042

Data presented as % (n) unless otherwise indicated.
aThere were no patients in our study with a recorded medical history of AIDS, paraplegia, congestive heart failure, peripheral vascular disease, metastatic disease, liver disease, renal failure, or gastrointestinal bleeds.
bP value was calculated using Student’s t test (continuous), χ ² (categorical), or Fisher’s exact test (categorical).
CCI, Charlson Comorbidity Index; PHQ-9, Patient Health Questionnaire-9.

Table 2

Operative characteristics by PHQ-9 score.

Characteristic	PHQ-9<5 (n = 186)	PHQ-95–10 (n = 94)	PHQ-9>10 (n = 71)	P value^b
Operative time,^a min, mean ± SD	49.8 ± 24.7	46.4 ± 20.2	50.8 ± 24.5	0.4160
Estimated blood loss, mL, mean ± SD	27.5 ± 11.5	28.9 ± 13.9	34.1 ± 57.5	0.239
Length of hospital stay, h, mean ± SD	9.4 ± 21.6	5.4 ± 23.9	8.5 ± 14.7	0.320
Discharge day, % (n)				0.183
POD 0	83.9% (156)	86.2% (81)	87.3% (62)
POD 1	14.5% (27)	8.5% (8)	8.5% (6)
POD 2	0.0% (0)	3.2% (3)	1.4% (1)
POD 3	1.6% (3)	2.1% (2)	2.8% (2)

aOperative time was measured from skin incision to skin closure.
bP value was calculated using Student’s t test (continuous), χ ² analysis (categorical), or Fisher’s exact test (categorical).
PHQ-9, Patient Health Questionnaire-9; POD, postoperative day.

Table 3

Postoperative mental health over predetermined time periods.

Table 4

Postoperative improvement (Delta) over predetermined time periods.

Table 5

Postoperative physical function and pain over predetermined time periods.

Data presented as mean ± SD (n).
aP value was calculated using linear regression.
PHQ-9, Patient Health Questionnaire-9; PROMIS-PF, Patient-Reported Outcomes Measurement Information System Physical Function; VAS, visual analog scale.

Table 6

Postoperative physical function and pain over predetermined time periods.

Data presented as mean ± SD (n).
aP value was calculated using linear regression.
PHQ-9, Patient Health Questionnaire-9; PROMIS-PF, Patient-Reported Outcomes Measurement Information System Physical Function; VAS, visual analog scale.