48. Depression severity and its impact on spine surgery outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> Patients with chronic back pain have an estimated two to three times greater prevalence of depression than the general population. Approximately one-third of patients with chronic back pain who undergo surgery suffer from symptoms of depression. Several studies have demonstrated preoperative depression to be a positive predictor of lower quality of life, greater pain, and morbidity in patients undergoing spine surgery. Depression is a disease with a wide spectrum of symptoms and severity. To our knowledge, there is a lack of information regarding what severity of depression leads to poorer outcomes following spine surgery. <h3>PURPOSE</h3> The purpose of this study is to investigate the impact of depression severity on perioperative outcomes in spine surgery patients using prospectively collected PROMIS Depression Scores. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis. <h3>PATIENT SAMPLE</h3> All patients >18 years of age who underwent spine surgery between January 1, 2010 and January 31, 2019. <h3>OUTCOME MEASURES</h3> Measures examined include: PROMIS depression scores, PROMIS physical functional scores, PROMIS pain interference scores, opioid use, length of stay and complications. <h3>METHODS</h3> A single center, retrospective review of patients >18 years of age who underwent spine surgery was performed. Study subjects undergoing spine surgery between January 1, 2017 – January 31, 2019 were included. Spine surgery was defined as the ICD-9/10 codes for laminectomy, discectomy and spinal arthrodesis. To be included in the study, patients required completed pre and postoperative PROMIS depression scores, as well as minimum 1-year follow up. Patient charts were reviewed for demographic and surgical data, PROMIS physical functional scores, PROMIS pain interference scores, opioid use, length of stay and complications. Patients were then divided into 4 groups based on severity of depression, PROMIS depression T scores 0 – 49 (no depression, Group 1), 50 – 54 (mild depression, Group 2), 55- 64 (moderate depression, Group 3) and 65+ (severe depression, Group 4). <h3>RESULTS</h3> A total of 139 patients were included: 39 (28.1%) Group 1, 30 (21.6%) Group 2, 54 (38.8%) Group 3, and 16 (11.5%) Group 4. There were no differences in regards to age, sex, BMI, smoking, procedure and Frailty index scores (p>0.05). Differences existed between preoperative diagnosis of depression (p=0.004) and preoperative depression medication use (p=0.013). Preoperative opioid use was highest in Group 4 at 35.7%, compared to 27.9% (Group 3), 4.2% (Group 2) and 9.4% (Group 1). Preoperative physical functional scores were worst in Group 4 and statistically significant as compared to Group 1 (p=0.015). Preoperative pain interference scores were worst in Group 4 and statistically significant as compared to Group 1 (p =0.004). Postoperative function and postoperative pain at 6 months were worst in Group 4 (p=0.008). <h3>CONCLUSIONS</h3> Patients with the most severe depression have both the worst pre- and postoperative functional and pain scores when compared to mild and moderate depression. Preoperative depression PROMIS scores may be an accurate method to judge control of depression symptoms prior to operating and ultimately may help in improving outcomes in spine surgery patients. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.