253. Mental health improvement predicts acute changes in physical health outcomes following minimally invasive lumbar decompression

Abstract

<h3>BACKGROUND CONTEXT</h3> Previous studies have assessed the impact of preoperative depressive symptoms on postoperative outcomes with inconsistent results. However, the influence of postoperative improvement in depression has not been assessed in terms of other patient-reported outcomes. <h3>PURPOSE</h3> To assess the association between improvement in depressive symptoms and other postoperative outcomes following minimally invasive lumbar decompression (MIS LD). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 193 patients undergoing primary, elective, single level MIS LD procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), 12-Item Short Form Physical Composite Score (SF-12 PCS), Oswestry Disability Index (ODI), visual analog scale (VAS) back and VAS leg. <h3>METHODS</h3> Prospectively collected data were recorded in a private surgical database and reviewed for primary, elective, single level MIS LD procedures. Patients lacking pre- or postoperative PHQ-9 data or whose procedures were indicated due to infection, malignancy, or trauma were excluded. Descriptive statistics were performed for patient demographics, preoperative spinal pathology, and perioperative characteristics. Patient reported outcome measures (PROMs) were administered at preoperative and 6-week, 12-week, 6-month, 1-year and 2-year postoperative timepoints. PROMs included PHQ-9, PROMIS PF, SF-12 PCS, ODI, VAS back and VAS leg. Delta (Δ) scores were calculated for each PROM based on postoperative improvement from preoperative baseline values. Achievement of a minimum clinically important difference (MCID) was determined by comparing Δ scores to the following previously established threshold values: AS back (2.2), VAS leg (5.0), ODI (8.2), SF-12 PCS (2.5), PROMIS PF (4.5). Postoperative improvement in PROM scores from preoperative baseline was assessed using a paired Student's t-test. Correlation between ΔPHQ-9 and other ΔPROM scores was assessed using Pearson's correlation coefficient. Multivariate regression analysis was used to assess PHQ-9 MCID achievement as a predictor of MCID achievement for other PROMs. <h3>RESULTS</h3> A total of 193 patients met inclusion/exclusion criteria. The study cohort had a mean age of 44.0 years, 72.0% were male, and the mean body mass index was 29.5 kg/m2. Herniated nucleus pulposus was the most common preoperative spinal pathology (92.8%). Mean perioperative characteristics were as follows: operative duration 39.8 minutes, estimated blood loss 25.6 mL and postoperative length of stay 4.8 hours. All PROMs demonstrated significant postoperative improvement from preoperative baseline (p≤0.012), with the exception of PHQ-9 at 2-years (p=0.248). ΔPHQ-9 was significant correlated with ΔPROMIS at 12-weeks through 1-year (all p≤0.002), ΔSF-12 PCS at 6-weeks through 1-year (all p≤0.018), ODI from 6-weeks through 6-months (all p≤0.024), VAS back at 6-weeks and 2-years (both p≤0.033), and VAS leg at 6-weeks only (p=0.009). Multivariate analysis revealed PHQ-9 MCID achievement as a significant predictor of MCID achievement in other PROMs at 12-weeks (p=0.005), 6-months (p<0.001) and overall (p=0.002). <h3>CONCLUSIONS</h3> Improvement in depressive symptoms, as measured by PHQ-9, was significantly associated with improvement in other PROMs primarily at short-term and intermediate postoperative timepoints. Therefore, lessening of depressive symptoms may be a particularly pertinent factor for overall outcomes in the first few months following MIS LD procedures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.