Friday, September 28, 2018 10:45 AM–12:00 PM abstracts: how should we measure our success: 185. Perioperative depression and anxiety correlate with patient-reported outcomes in spine surgery

Abstract

BACKGROUND CONTEXT Multiple studies have demonstrated that patients present with psychiatric symptoms prior to spine surgery and that psychiatric distress has a negative impact on patient-reported outcomes (PROs). However, how the preoperative to postoperative progression of depression or anxiety correlate with PROs is unknown. PURPOSE To identify patterns of preoperative to postoperative depression and anxiety progression in spine surgery patients, and to compare PROs across depression and anxiety progression groups. STUDY DESIGN/SETTING Retrospective review of spine surgery patients at the Johns Hopkins Hospital. PATIENT SAMPLE A total of 240 spine patients. OUTCOME MEASURES Patient-Reported Outcomes Measurement Information System (PROMIS) Computerized Adaptive Test (CAT) scores in Depression, Anxiety, Pain Interference, Physical Function, Sleep Disturbance, and Satisfaction with Participation in Social Roles. METHODS PROMIS Depression, Anxiety, Pain Interference, Physical Function, Sleep Disturbance, and Satisfaction with Participation in Social Roles were assessed in 240 spine patients preoperatively and at 3 months postoperatively. Patients were stratified based on perioperative progression of depression or anxiety scores using American Psychiatric Association PROMIS guidelines into Persistent, Postoperatively-Improved, Postoperatively-Developed, or No Psychiatric Distress. Multivariate regressions compared changes in PROs, adjusting for age, race, gender, smoking status, working status, income level, education level, and baseline outcomes scores. RESULTS Of the 240 patients (avg. age: 58.4 years; 87% White, 8% African American, 5% Other; 45% male), 26.5% had preoperative depression, of whom 52% postoperatively improved. 44.2% had preoperative anxiety, of whom 21% postoperatively improved. Of patients with no preoperative depression, 9% postoperatively developed depression, and of those with no preoperative anxiety, 11% postoperatively developed anxiety. Patients whose depression persisted had similar preoperative depression scores to patients whose depression improved. Similar results were observed with anxiety. Persistently Depressed patients had less improvement (p CONCLUSIONS Many patients saw postoperative improvement of preoperative depression or anxiety, perhaps from alleviation of spine pathology. Patient-reported outcomes (PROs) are worse in those with postoperative depression (persistent or newly developed), or newly developed anxiety. Postoperative depression or anxiety may have a greater effect on PROs than preoperative psychiatric distress.