Rahman Rafa, Ibaseta Alvaro, Reidler Jay S, Andrade Nicholas S, Skolasky Richard L, Riley Lee H, Cohen David B, Sciubba Daniel M, Kebaish Khaled M, Neuman Brian J
Departments of1Orthopaedic Surgery and.
2Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Neurosurg Spine. 2020 Jan 31;32(6):871-890. doi: 10.3171/2019.11.SPINE19586. Print 2020 Jun 1.
The authors conducted a study to analyze associations between changes in depression/anxiety before and 12 months after spine surgery, as well as changes in scores using the Patient-Reported Outcomes Measurement Information System (PROMIS) at the same time points.
Preoperatively and 12 months postoperatively, the authors assessed PROMIS scores for depression, anxiety, pain, physical function, sleep disturbance, and satisfaction with participation in social roles among 206 patients undergoing spine surgery for deformity correction or degenerative disease. Patients were stratified according to preoperative/postoperative changes in depression and anxiety, which were categorized as persistent, improved, newly developed postoperatively, or absent. Multivariate regression was used to control for confounders and to compare changes in patient-reported outcomes (PROs).
Fifty patients (24%) had preoperative depression, which improved in 26 (52%). Ninety-four patients (46%) had preoperative anxiety, which improved in 70 (74%). Household income was the only preoperative characteristic that differed significantly between patients whose depression persisted and those whose depression improved. Compared with the no-depression group, patients with persistent depression had less improvement in all 4 domains, and patients with postoperatively developed depression had less improvement in pain, physical function, and satisfaction with social roles. Compared with the group of patients with postoperatively improved depression, patients with persistent depression had less improvement in pain and physical function, and patients with postoperatively developed depression had less improvement in pain. Compared with patients with no anxiety, those with persistent anxiety had less improvement in physical function, sleep disturbance, and satisfaction with social roles, and patients with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. Compared with patients with postoperatively improved anxiety, patients with persistent anxiety had less improvement in pain, physical function, and satisfaction with social roles, and those with postoperatively developed anxiety had less improvement in pain, physical function, and satisfaction with social roles. All reported differences were significant at p < 0.05.
Many spine surgery patients experienced postoperative improvements in depression/anxiety. Improvements in 12-month PROs were smaller among patients with persistent or postoperatively developed depression/anxiety compared with patients who had no depression or anxiety before or after surgery and those whose depression/anxiety improved after surgery. Postoperative changes in depression/anxiety may have a greater effect than preoperative depression/anxiety on changes in PROs after spine surgery. Addressing the mental health of spine surgery patients may improve postoperative PROs.■ CLASSIFICATION OF EVIDENCE Type of question: causation; study design: prospective cohort study; evidence: class III.
作者开展了一项研究，以分析脊柱手术前及术后12个月抑郁/焦虑的变化之间的关联，以及在相同时间点使用患者报告结局测量信息系统（PROMIS）的评分变化。
作者在术前及术后12个月，对206例因脊柱畸形矫正或退行性疾病接受脊柱手术的患者进行了抑郁、焦虑、疼痛、身体功能、睡眠障碍以及参与社会角色满意度的PROMIS评分评估。患者根据术前/术后抑郁和焦虑的变化进行分层，分为持续存在、改善、术后新发或不存在。采用多因素回归分析来控制混杂因素，并比较患者报告结局（PROs）的变化。
50例患者（24%）术前存在抑郁，其中26例（52%）有所改善。94例患者（46%）术前存在焦虑，其中70例（74%）有所改善。家庭收入是抑郁持续存在的患者与抑郁改善的患者之间唯一有显著差异的术前特征。与无抑郁组相比，抑郁持续存在的患者在所有4个领域的改善均较小，术后新发抑郁的患者在疼痛、身体功能及社会角色满意度方面的改善较小。与术后抑郁改善的患者组相比，抑郁持续存在的患者在疼痛和身体功能方面的改善较小，术后新发抑郁的患者在疼痛方面的改善较小。与无焦虑患者相比，焦虑持续存在的患者在身体功能、睡眠障碍及社会角色满意度方面的改善较小，术后新发焦虑的患者在疼痛、身体功能及社会角色满意度方面的改善较小。与术后焦虑改善的患者相比，焦虑持续存在的患者在疼痛、身体功能及社会角色满意度方面的改善较小，术后新发焦虑的患者在疼痛、身体功能及社会角色满意度方面的改善较小。所有报告的差异均在p<0.05水平具有统计学意义。
许多脊柱手术患者术后抑郁/焦虑状况有所改善。与术前及术后无抑郁或焦虑以及术后抑郁/焦虑得到改善的患者相比，抑郁/焦虑持续存在或术后新发的患者在12个月的PROs方面改善较小。脊柱手术后抑郁/焦虑的术后变化可能比术前抑郁/焦虑对PROs变化的影响更大。关注脊柱手术患者的心理健康可能会改善术后PROs。■证据分类问题类型：因果关系；研究设计：前瞻性队列研究；证据等级：III级。
