The Association Between PHQ-2 Screening and Patient Satisfaction and Return to Work Up To 2-Years After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Abstract

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality improvement collaborative. Using MSSIC, we sought to identify the relationship between a positive PHQ-2, which is predictive of depression, and patient satisfaction, return to work, and achieving ODI MCID up to 2-yr after lumbar fusion. METHODS A total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the NASS patient satisfaction index. A positive PHQ-2 score is =3, which has a 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equations (GEE) models were constructed; variables tested include age, gender, race, PMH, preoperative diagnosis (disc herniation, spondylolisthesis, etc), preoperative symptoms (axial pain, radicular pain, etc), severity of surgery, and preoperative opioid usage. RESULTS Patients with a positive PHQ-2 score were less likely to be satisfied after lumbar fusion at 90-d (OR 0.93, P < .001), 1-yr (OR 0.92, P = .001), and 2-yr (OR 0.92, P = .028). A positive PHQ-2 was also associated with decreased likelihood of returning to work at 90-d (OR 0.76, P < .001), 1-yr (OR 0.85, P = .001), and at 2-yr (OR 0.82, P = .031). A positive PHQ-2 was predictive of failure to achieve ODI MCID at 90-d (OR 1.07, P = .005) but not at 1-yr or 2-yr after lumbar fusion. CONCLUSION A multivariate analysis from a large, multicenter, prospective database on lumbar fusion patients was performed. We find that PHQ-2, which is a simple and accurate screening tool for depression, is associated with an inability to return to work and worse satisfaction up to 2-yr after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, then perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.