Zakaria Hesham Mostafa, Mansour Tarek R, Telemi Edvin, Asmaro Karam, Macki Mohamed, Bazydlo Michael, Schultz Lonni, Nerenz David R, Abdulhak Muwaffak, Schwalb Jason M, Park Paul, Chang Victor
1Department of Neurosurgery.
2Center for Health Services Research, and.
J Neurosurg Spine. 2019 Aug 23;31(6):794-801. doi: 10.3171/2019.6.SPINE1963. Print 2019 Dec 1.
The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire-2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion.
Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is ≥ 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage.
Multivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion.
A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.
密歇根脊柱手术改善协作组（MSSIC）是一项前瞻性、纵向、多中心的质量改进协作项目。作者利用MSSIC，试图确定预测抑郁症的患者健康问卷-2（PHQ-2）筛查呈阳性与患者满意度、重返工作岗位以及腰椎融合术后长达2年实现奥斯维斯特里残疾指数（ODI）最小临床重要差异（MCID）评分之间的关系。
分析了总共8585例腰椎融合患者的数据。患者满意度通过北美脊柱协会患者满意度指数进行测量。PHQ-2评分≥3为阳性，该评分在检测重度抑郁症方面的敏感度为82.9%，特异度为90.0%。构建了广义估计方程模型；测试的变量包括年龄、性别、种族、既往病史、手术严重程度和术前阿片类药物使用情况。
进行了多变量分析。PHQ-2评分阳性（即≥3）的患者在腰椎融合术后90天（相对风险[RR]0.93，p<0.001）、1年（RR 0.92，p = 0.001）和2年（RR 0.92，p = 0.028）时满意度较低。PHQ-2评分阳性还与术后90天（RR 0.76，p<0.001）、1年（RR 0.85，p = 0.001）和2年（RR 0.82，p = 0.031）重返工作岗位的可能性降低相关。PHQ-2评分阳性可预测腰椎融合术后90天未能达到ODI MCID（RR 1.07，p = 0.005），但在术后1年或2年时不能预测。
基于一个大型、多中心、前瞻性腰椎融合患者数据库的信息进行了多变量分析。作者发现，PHQ-2评分阳性（≥3），这是一种简单且准确的抑郁症筛查工具，可预测腰椎融合术后长达2年无法重返工作岗位以及满意度较差。抑郁症是一种可治疗的疾病，因此，如同患者在手术前进行医学优化以降低术后发病率一样，或许患者术前应进行精神方面的优化以改善术后功能结局。
