Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion

ABSTRACT Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis. Methods: Patients undergoing 1- to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart. Patients were separated into 3 groups: no depression or anxiety (NDA), depression or anxiety alone (DOA), and combined depression and anxiety (DAA). Absolute PROMs, recovery ratios, and the percentage of patients achieving minimal clinically important difference (% MCID) between groups were compared using univariate and multivariate analysis. Results: Of the 391 patients included in the cohort, 323 (82.6%) were in the NDA group, 37 (9.5%) in the DOA group, and 31 (7.9%) in the DAA group. Patients in the DAA group had significantly worse outcome scores before and after surgery with respect to Short Form-12 mental component score (MCS-12) and Oswestry Disability Index (ODI) scores (P <.001); however, the change in PROMs, recovery ratio, % MCID were not found to be significantly different between groups. Using multivariate analysis, the DAA group was found to be an independent predictor of worse improvement in MCS-12 and ODI scores (P = .026 and P = .001, respectively). Conclusions: Patients with combined anxiety and depression fared worse with respect to disability before and after surgery compared to patients with a single diagnosis or no mental health diagnosis; however, there were no significant differences in recovery ratio or % MCID. Level of Evidence: 3. Clinical Relevance: Combined anxiety and depression may predict less improvement in MCS-12 and ODI after lumbar arthrodesis compared with single or no mental health diagnosis.