219. Assessing PHQ-9 vs SF-12 mental composite score as predictors of postoperative outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> A number of previous studies have demonstrated the significance of preoperative mental health scores, such as the Patient-Health Questionnaire-9 and the 12-Item Short Form Mental Composite Score (SF-12 MCS), as predictors of postoperative patient-reported outcome measures (PROMs) for physical health. However, these measures have not yet been compared as predictors of physical health outcomes following spine surgery. <h3>PURPOSE</h3> To assess the predictive value of PHQ-9 and SF-12 MCS in patients undergoing minimally invasive lumbar decompression (MIS LD). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 416 patients undergoing primary, elective, single- or multilevel MIS LD procedures for degenerative spinal pathology. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), Short Form 12 Mental Composite Score (SF-12 MCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Composite Score (PCS), visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI). <h3>METHODS</h3> A prospectively maintained surgical database was retrospectively reviewed for patients who underwent primary, elective, single- or multilevel MIS LD procedures for degenerative spinal pathology. Patient demographics, baseline characteristics, pre-existing spinal pathology, and perioperative outcomes were collected. PROMs including PHQ-9, SF-12 MCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Composite Score (PCS), Visual analog scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were administered preoperatively and at postoperative timepoints. Descriptive statistics were performed for baseline and perioperative variables. Paired Student's t-test was used to assess postoperative improvement in PROM scores from preoperative baseline. PHQ-9 and SF-12 MCS were assessed as predictors of postoperative scores in other PROMs using linear regression analysis at each timepoint. Post-hoc estimations were performed using standardized beta coefficients to compare PHQ-9 and SF-12 MCS as predictors of postoperative PROM scores. <h3>RESULTS</h3> A total of 416 MIS LD patients were included with a mean age of 45.7. A majority were male (69.0%), and non-obese (58.2%). Mean preoperative PHQ-9 and SF-12 MCS scores were 5.8 ± 5.5 and 48.8 ± 11.8, respectively. PROMIS PF, SF-12 PCS, VAS back, VAS leg, and ODI demonstrated significant improvements from preoperative baseline at all postoperative timepoints (all p<0.001). PHQ-9 was a significant predictor of PROMIS PF and SF-12 at preoperative, 6-week, 12-week, and 2-year timepoints (all p≤0.045), VAS back at all timepoints except 1-year (all p≤0.047), VAS leg at preoperative, 6-week, 12-week, and 1-year timepoints (all p≤0.021), and ODI from preoperative through 1-year timepoints (all p≤0.005). SF-12 MCS was a significant predictor of PROMIS PF at preoperative, 6-week, 12-week, and 2-year timepoints (all p≤0.016), SF-12 PCS at 6-week, 12-week, and 2-year timepoints (all p≤0.022), VAS back at preoperative, 12-week, and 6-month timepoints (all p≤0.017), and VAS leg and ODI at all timepoints except 2-years (all p≤0.025). Significant differences in effect size as predictor variables were demonstrated between PHQ-9 and SF-12 MCS at all timepoints except 6-months and 1-year for PROMIS PF and SF-12 PCS (all p≤0.027), 1-year for VAS back (all p≤0.015), and 2-years for VAS leg (all p≤0.014). <h3>CONCLUSIONS</h3> Both PHQ-9 and SF-12 MCS were demonstrated as significant predictors of physical function, pain, and disability PROMs at most timepoints. However, significant differences in the effect sizes of these predictive models were demonstrated. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.