PT  - JOURNAL ARTICLE
AU  - Goyal, Dhruv K.C.
AU  - Stull, Justin D.
AU  - Divi, Srikanth N.
AU  - Galetta, Matthew S.
AU  - Bowles, Daniel R.
AU  - Nicholson, Kristen J.
AU  - Kaye, I. David
AU  - Woods, Barrett I.
AU  - Kurd, Mark F.
AU  - Radcliff, Kris E.
AU  - Rihn, Jeffrey A.
AU  - Anderson, D. Greg
AU  - Hilibrand, Alan S.
AU  - Kepler, Christopher K.
AU  - Vaccaro, Alexander R.
AU  - Schroeder, Gregory D.
TI  - Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion
AID  - 10.14444/8008
DP  - 2021 Apr 01
TA  - International Journal of Spine Surgery
PG  - 234--242
VI  - 15
IP  - 2
4099  - https://www.ijssurgery.com/content/15/2/234.short
4100  - https://www.ijssurgery.com/content/15/2/234.full
SO  - Int J Spine Surg2021 Apr 01; 15
AB  - Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis.Methods: Patients undergoing 1- to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart. Patients were separated into 3 groups: no depression or anxiety (NDA), depression or anxiety alone (DOA), and combined depression and anxiety (DAA). Absolute PROMs, recovery ratios, and the percentage of patients achieving minimal clinically important difference (% MCID) between groups were compared using univariate and multivariate analysis.Results: Of the 391 patients included in the cohort, 323 (82.6%) were in the NDA group, 37 (9.5%) in the DOA group, and 31 (7.9%) in the DAA group. Patients in the DAA group had significantly worse outcome scores before and after surgery with respect to Short Form-12 mental component score (MCS-12) and Oswestry Disability Index (ODI) scores (P <.001); however, the change in PROMs, recovery ratio, % MCID were not found to be significantly different between groups. Using multivariate analysis, the DAA group was found to be an independent predictor of worse improvement in MCS-12 and ODI scores (P = .026 and P = .001, respectively).Conclusions: Patients with combined anxiety and depression fared worse with respect to disability before and after surgery compared to patients with a single diagnosis or no mental health diagnosis; however, there were no significant differences in recovery ratio or % MCID.Level of Evidence: 3.Clinical Relevance: Combined anxiety and depression may predict less improvement in MCS-12 and ODI after lumbar arthrodesis compared with single or no mental health diagnosis.