TY - JOUR
T1 - Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery
T2 - The importance of risk stratification based on type of psychological distress
AU - International Spine Study Group
AU - Theologis, Alexander A.
AU - Ailon, Tamir
AU - Scheer, Justin K.
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Bess, Shay
AU - Gupta, Munish
AU - Klineberg, Eric O.
AU - Kebaish, Khaled
AU - Schwab, Frank
AU - Lafage, Virginie
AU - Burton, Douglas
AU - Hart, Robert
AU - Ames, Christopher P.
N1 - Funding Information:
Funding for the International Spine Study Group Foundation, through which this study was conducted, was provided by research grants from DePuy Spine and individual donations. Dr. Shaffrey is a consultant for Biomet, Medtronic, and Nuvasive; owns stock in Nuvasive; and is a patent holder with and receives royalty payments from Biomet, Medtronic, and Nuvasive. Dr. Smith is a consultant for Biomet, Nuvasive, and Cerapedics; received clinical or research support for this study from DePuy/ISSGF; receives support for other non-study-related clinical and/or research from DePuy/ISSGF; and receives royalties from Biomet. Dr. Hart is a consultant for DePuy Synthes and Globus; is a patent holder with OHSU; receives nonrelated grants from Medtronic; receives royalties from Seaspine and DePuy Synthes; is a board member of CSRS, ISSLS, and ISSG (has received no financial compensation to date); and performs speaking engagements for DePuy and Globus. Dr. Lafage has ownership interest and direct stock ownership in Nemaris INC; is a consultant for NuVasive; has speaking/teaching arrangements with Medicrea, DePuy Spine, NuVasive, and Nemaris INC; and receives support of non-study-related clinical/research efforts she oversees from SRS, NIH, and DePuy Spine. Dr. Schwab has ownership of and direct stock ownership in Nemaris INC; is a consultant for K2M, NuVasive, Medicrea, Zimmer-Biomer, and MSD; is a patent holder for MSD and K2M; receives support for other non-study-related clinical/research efforts from AO, DePuy, and SRS; and has speaking/teaching arrangements with K2M, NuVasive, Medicrea, Zimmer-Biomer, and MSD. Dr. Burton received clinical/research support (equipment/material) from DePuy for this study and is a consultant and a patent holder for DePuy. Dr. Bess is a consultant for K2M and Allosource; is a patent holder for K2M and Innovasis; received clinical/research support for this study; and receives support for other non-study-related clinical/research efforts from Medtronic, Stryker, K2M, and Innovasis. Dr. Ames is a consultant for DePuy, Medtronic, and Stryker; has direct stock ownership in Doctors Research Group; is a patent holder for Fish and Richardson, P.C.; and receives royalties from Biomet Spine and Stryker. Dr. Gupta is a consultant for DePuy and Medtronic; has direct stock ownership in Orthofix, Proctor and Gamble, Pfizer, Johnson and Johnson, and Pioneer; and receives royalties from DePuy. Dr. Klineberg is a consultant for DePuy Synthes and Stryker; and receives an honorarium from AO Spine and a grant for a fellowship from K2M.
Publisher Copyright:
©AANS, 2016.
PY - 2016/10
Y1 - 2016/10
N2 - OBJECTIVE: The objective of this study was to isolate whether the effect of a baseline clinical history of depression on outcome is independent of associated physical disability and to evaluate which mental health screening tool has the most utility in determining 2-year clinical outcomes after adult spinal deformity (ASD) surgery. METHODS: Consecutively enrolled patients with ASD in a prospective, multicenter ASD database who underwent surgical intervention with a minimum 2-year follow-up were retrospectively reviewed. A subset of patients who completed the Distress and Risk Assessment Method (DRAM) was also analyzed. The effects of categorical baseline depression and DRAM classification on the Oswestry Disability Index (ODI), SF-36, and Scoliosis Research Society questionnaire (SRS-22r) were assessed using univariate and multivariate linear regression analyses. The probability of achieving ≥ 1 minimal clinically important difference (MCID) on the ODI based on the DRAM's Modified Somatic Perceptions Questionnaire (MSPQ) score was estimated. RESULTS: Of 267 patients, 66 (24.7%) had self-reported preoperative depression. Patients with baseline depression had significantly more preoperative back pain, greater BMI and Charlson Comorbidity Indices, higher ODIs, and lower SRS-22r and SF-36 Physical/Mental Component Summary (PCS/MCS) scores compared with those without self-reported baseline depression. They also had more severe regional and global sagittal malalignment. After adjusting for these differences, preoperative depression did not impact 2-year ODI, PCS/MCS, or SRS-22r totals (p > 0.05). Compared with those in the "normal" DRAM category, "distressed somatics" (n = 11) had higher ODI (+23.5 points), lower PCS (-10.9), SRS-22r activity (-0.9), and SRS-22r total (-0.8) scores (p ≤ 0.01), while "distressed depressives" (n = 25) had lower PCS (-8.4) and SRS-22r total (-0.5) scores (p < 0.05). After adjusting for important covariates, each additional point on the baseline MSPQ was associated with a 0.8-point increase in 2-year ODI (p = 0.03). The probability of improving by at least 1 MCID in 2-year ODI ranged from 77% to 21% for MSPQ scores 0-20, respectively. CONCLUSIONS: A baseline clinical history of depression does not correlate with worse 2-year outcomes after ASD surgery after adjusting for baseline differences in comorbidities, health-related quality of life, and spinal deformity severity. Conversely, DRAM improved risk stratification of patient subgroups predisposed to achieving suboptimal surgical outcomes. The DRAM's MSPQ was more predictive than MCS and SRS mental domain for 2-year outcomes and may be a valuable tool for surgical screening.
AB - OBJECTIVE: The objective of this study was to isolate whether the effect of a baseline clinical history of depression on outcome is independent of associated physical disability and to evaluate which mental health screening tool has the most utility in determining 2-year clinical outcomes after adult spinal deformity (ASD) surgery. METHODS: Consecutively enrolled patients with ASD in a prospective, multicenter ASD database who underwent surgical intervention with a minimum 2-year follow-up were retrospectively reviewed. A subset of patients who completed the Distress and Risk Assessment Method (DRAM) was also analyzed. The effects of categorical baseline depression and DRAM classification on the Oswestry Disability Index (ODI), SF-36, and Scoliosis Research Society questionnaire (SRS-22r) were assessed using univariate and multivariate linear regression analyses. The probability of achieving ≥ 1 minimal clinically important difference (MCID) on the ODI based on the DRAM's Modified Somatic Perceptions Questionnaire (MSPQ) score was estimated. RESULTS: Of 267 patients, 66 (24.7%) had self-reported preoperative depression. Patients with baseline depression had significantly more preoperative back pain, greater BMI and Charlson Comorbidity Indices, higher ODIs, and lower SRS-22r and SF-36 Physical/Mental Component Summary (PCS/MCS) scores compared with those without self-reported baseline depression. They also had more severe regional and global sagittal malalignment. After adjusting for these differences, preoperative depression did not impact 2-year ODI, PCS/MCS, or SRS-22r totals (p > 0.05). Compared with those in the "normal" DRAM category, "distressed somatics" (n = 11) had higher ODI (+23.5 points), lower PCS (-10.9), SRS-22r activity (-0.9), and SRS-22r total (-0.8) scores (p ≤ 0.01), while "distressed depressives" (n = 25) had lower PCS (-8.4) and SRS-22r total (-0.5) scores (p < 0.05). After adjusting for important covariates, each additional point on the baseline MSPQ was associated with a 0.8-point increase in 2-year ODI (p = 0.03). The probability of improving by at least 1 MCID in 2-year ODI ranged from 77% to 21% for MSPQ scores 0-20, respectively. CONCLUSIONS: A baseline clinical history of depression does not correlate with worse 2-year outcomes after ASD surgery after adjusting for baseline differences in comorbidities, health-related quality of life, and spinal deformity severity. Conversely, DRAM improved risk stratification of patient subgroups predisposed to achieving suboptimal surgical outcomes. The DRAM's MSPQ was more predictive than MCS and SRS mental domain for 2-year outcomes and may be a valuable tool for surgical screening.
KW - Adult spinal deformity
KW - Depression
KW - Distress and risk assessment method
KW - Health-related quality of life
KW - Psychological distress
KW - Risk stratification
UR - http://www.scopus.com/inward/record.url?scp=84990845555&partnerID=8YFLogxK
U2 - 10.3171/2016.2.SPINE15980
DO - 10.3171/2016.2.SPINE15980
M3 - Article
C2 - 27153146
AN - SCOPUS:84990845555
SN - 1547-5654
VL - 25
SP - 477
EP - 485
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 4
ER -