Carreon Leah Y, Djurasovic Mladen, Dimar John R, Owens R Kirk, Crawford Charles H, Puno Rolando M, Bratcher Kelly R, McGraw Katlyn E, Glassman Steven D
Norton Leatherman Spine Center, Louisville; and.
Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
J Neurosurg Spine. 2016 Sep;25(3):352-6. doi: 10.3171/2016.2.SPINE151472. Epub 2016 May 6.
OBJECTIVE Studies have shown that anxious or depressed patients may have poorer outcomes after lumbar fusion. These conclusions were drawn from questionnaires specifically designed to measure anxiety and depression. The objective of this study is to determine if responses to the EQ-5D anxiety/depression domain or the items used to calculate the 36-Item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) can predict outcomes after lumbar fusion surgery. METHODS Patients enrolled in the National Neurosurgery Quality and Outcomes Database from a single center with 1-year follow-up were identified. The outcomes collected include the Oswestry Disability Index (ODI), EQ-5D, SF-36, and the back- and leg-pain numeric rating scales (range 0-10). Linear regression modeling was performed to predict the 1-year ODI scores using the EQ-5D anxiety/depression domain and the 14 items used to calculate SF-36 MCS. RESULTS Complete data were available for 312 (88%) of 353 eligible patients. The mean patient age was 58.5 years, 175 (56%) patients were women, and 52 patients were smokers. After controlling for other factors, the item in the SF-36 that asks "Have you felt downhearted and depressed?" is the strongest predictor of the 1-year ODI score (r(2) = 0.191; p = 0.000) and 1-year EQ-5D score (r(2) = 0.205; p = 0.000). Neither the EQ-5D anxiety/depression domain nor the diagnoses of anxiety or depression were predictors of 1-year outcomes. CONCLUSIONS Patient responses to SF-36 item "Have you felt downhearted and depressed?" account for 20% of the variability of the 1-year ODI and EQ-5D scores and can be used by clinicians to screen for anxiety or depression in patients prior to lumbar fusion surgery. Clinicians may offer psychological support to these patients preoperatively in order to improve treatment outcomes.
目的 研究表明，焦虑或抑郁患者在腰椎融合术后可能预后较差。这些结论是通过专门设计用于测量焦虑和抑郁的问卷得出的。本研究的目的是确定对EQ-5D焦虑/抑郁领域的回答或用于计算36项简短健康调查（SF-36）心理成分总结（MCS）的项目是否能够预测腰椎融合手术后的结果。方法 从单一中心纳入国家神经外科质量与结果数据库且有1年随访的患者。收集的结果包括奥斯威斯功能障碍指数（ODI）、EQ-5D、SF-36以及背部和腿部疼痛数字评分量表（范围0至10）。进行线性回归建模，以使用EQ-5D焦虑/抑郁领域和用于计算SF-36 MCS的14个项目预测1年ODI评分。结果 353例符合条件的患者中有312例（88%）获得了完整数据。患者平均年龄为58.5岁，175例（56%）为女性，52例为吸烟者。在控制其他因素后，SF-36中询问“你是否感到沮丧和抑郁？”的项目是1年ODI评分（r² = 0.191；p = 0.000）和1年EQ-5D评分（r² = 0.205；p = 0.000）的最强预测因素。EQ-5D焦虑/抑郁领域以及焦虑或抑郁的诊断均不是1年结果的预测因素。结论 患者对SF-36项目“你是否感到沮丧和抑郁？”的回答占1年ODI和EQ-5D评分变异性的20%，临床医生可在腰椎融合手术前用于筛查患者的焦虑或抑郁。临床医生可在术前为这些患者提供心理支持，以改善治疗结果。
