Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Background: Spine surgery patients have greater rates of preoperative depression and anxiety than the public, with about 1 in 3 patients experiencing these mental health conditions. PROMIS Depression survey measures the cognitive and affective manifestations of depression. This survey has been found to correlate well with formal depression screening tools, such as the Patient Health Questionnaire-9 (PHQ-9). The purpose of this study is to assess the effects of depression on patient-reported outcomes and its potential underdiagnoses in our patient population.

Methods: Patients who underwent lumbar decompression ± ≤ 2 level fusion at a single institution between March 2019 and January 2021 were identified from a prospectively maintained database. PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative intake with subsequent follow-up at 6 and 12 months postoperatively. Patients were categorized based on clinical diagnosis of depression by a psychiatrist prior to surgery. Between cohort comparisons of the mean for each PROMIS measure were performed using a simple t-test. Subsequent analysis was conducted on patients with a diagnosis of depression based on PROMIS Depression score cutoff of ≥ 53¹. We controlled for variables that may be independent predictors of self-reported health status including age, gender, co-morbidities, length of stay, duration of surgery, and surgical invasiveness index.

Results: One hundred and fifteen patients met our inclusion criteria of completed PROMIS surveys at the designated time points. A total of 37 (32.2%) patients were diagnosed with depression prior to surgery. Analysis of patient-reported health outcomes shows that depression correlated with worse ODI (47.1±18.0 vs. 36.6±18.2, p=0.005) and Depression (59.0±9.21 vs. 52.4±7.71, p<0.001), Fatigue (57.1± 8.07 vs. 49.5±7.36, p<0.001), and PI (59.6±8.68 vs. 51.5±10.8, p<0.001) scores at baseline. At 1-year follow-up, patients with depression continued to have worse PROMIS Depression (55.1±7.90 vs. 48.5±9.59, p<0.001), Fatigue (53.4±8.55 vs. 47.0±8.14, p<0.001), and PI (51.9±10.2 vs. 47.1±10.5, p=0.021). Based on PROMIS Depression cutoff score of ≥ 53, twenty-eight out of seventy-eight patients without a clinical diagnosis of depression (35.9%) met the criteria for depression (see Figure 1). Patients with suspected depression had significantly worse preoperative scores across all survey domains with the exception of PROMIS SR and SD compared to patients without a clinical diagnosis of depression (see figure 2). Subsequent comparison between patients with a clinical diagnosis of depression and patients with suspected depression based on PROMIS Depression scores revealed no difference in patient-reported outcome scores across all survey domains (see Figure 3).

Conclusion: Our findings suggest that depression is associated with worse patient-reported outcome metrics and that depression is potentially underdiagnosed in spine patients. Consideration of utilizing PROMIS Depression scores as a screening tool for depression could aid in detecting this risk factor in our spine patients. Future work is needed to understand the role of treating depression and psychiatry intervention in preoperative optimization for lumbar surgery.