Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms

Abstract

Background ContextPreoperative psychological symptoms predict surgical outcomes. The impact of surgical outcomes on psychological well-being, however, has not been delineated. PurposeThis study aimed to compare pre- with postoperative depressive and anxiety symptoms based on success of surgery, defined as fulfilled expectations and improvement in disability and pain. Study Design/SettingA prospective 2-year longitudinal study in a tertiary care center was carried out. Patient SampleThe sample consisted of 276 patients who underwent lumbar surgery. Outcome MeasuresThe Geriatric Depression Scale (GDS) and the Spielberger State-Trait Anxiety Inventory (STAI) were the outcome measures. MethodsPatients completed the following validated surveys several days before and again 2 years after surgery: the GDS with a set threshold for a positive screen for depression; the STAI with population norms used as threshold values; the Oswestry Disability Index (ODI); a numerical pain rating; and the Expectations Survey measuring amount of improvement expected. Dependent variables were pre- to postoperative within-patient change in GDS and STAI scores. Independent variables were three outcomes of surgery: proportion of expectations fulfilled, and changes in ODI scores and pain ratings. Analyses were conducted with GDS and STAI scores as continuous variables and according to threshold values, and for expectations, ODI and pain according to minimum clinically important differences (MCIDs). ResultsMean age was 55, 56% were men, and 78% had degenerative diagnoses. For depressive symptoms, 41% screened positive preoperatively and 16% screened positive postoperatively; 72% had some improvement. In multivariable analysis adjusted for age, gender, comorbidity, diagnosis, and surgical invasiveness, depressive symptoms improved more for more expectations fulfilled (p<.0001), more ODI improvement (p<.0001), and more pain improvement (p=.001). For anxiety symptoms: 59% were worse than population norms preoperatively and 26% were worse postoperatively; 73% had some improvement. In adjusted multivariable analyses, anxiety symptoms improved more for more expectations fulfilled (p=.0002), more ODI improvement (p<.0001), and more pain improvement (p=.03). Similar results were obtained according to threshold values and MCIDs. ConclusionSubstantial improvements in psychological well-being resulted after surgery among patients with favorable spine-specific outcomes.