The impact of preoperative depression on quality of life outcomes after posterior cervical fusion.

Autor: Alvin MD; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA., Miller JA; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA., Sundar S; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA., Lockwood M; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA., Lubelski D; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA., Nowacki AS; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA., Scheman J; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Neurological Center for Pain, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA., Mathews M; Neurological Center for Pain, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA., McGirt MJ; Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave, Charlotte, NC 28204, USA., Benzel EC; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA., Mroz TE; Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2015 Jan 01; Vol. 15 (1), pp. 79-85. Date of Electronic Publication: 2014 Jul 09.
DOI: 10.1016/j.spinee.2014.07.001
Abstrakt: Background Context: Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs. To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery. Affective disorders, such as depression, are associated with worsened outcomes after lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery.
Purpose: To assess the predictive value of preoperative depression and the health state on 1-year quality of life (QOL) outcomes after PCF.
Study Design: A retrospective cohort analysis.
Patient Sample: Eighty-eight patients who underwent PCF for cervical spondylosis were reviewed.
Outcome Measures: Preoperative and 1-year postoperative health outcomes were assessed based on the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire-9 (PHQ-9), and the EuroQol five-dimensions (EQ-5D) questionnaire.
Methods: Univariable and multivariable regression analyses were performed to assess for preoperative predictors of 1-year change in health status.
Results: Compared with preoperative health states, the PCF cohort showed statistically significant improved PDQ (87.8 vs. 73.6), PHQ-9 (7.7 vs. 6.6), and EQ-5D (0.50 vs. 0.60) scores at 1 year postoperatively. Only 10/88 (11%) patients achieved or surpassed the minimum clinically important difference for the PHQ-9 (5). Multiple linear and logistic regression analyses showed that increasing PHQ-9 and EQ-5D preoperative scores were associated with reduced 1-year postoperative improvement in health status (EQ-5D index).
Conclusions: Of patients who undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared with those with less depression. Additionally, patients with better preoperative health states also attain lower 1-year QOL improvements.
(Copyright © 2015 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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