术前患者健康问卷-9评分升高对腰椎减压术后临床改善的流行病学相关性
Epidemiological Relevance of Elevated Preoperative Patient Health Questionnaire-9 Scores on Clinical Improvement Following Lumbar Decompression.
作者信息
Parrish James M, Jenkins Nathaniel W, Cha Elliot D K, Lynch Conor P, Geoghegan Cara E, Jadczak Caroline N, Mohan Shruthi, Singh Kern
机构信息
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
出版信息
Int J Spine Surg. 2022 Feb;16(1):159-167. doi: 10.14444/8184.
BACKGROUND
Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD.
METHODS
A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back.
RESULTS
The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 <5), 94 had moderate (5≤ PHQ-9 ≤10), and 71 had severe (PHQ-9 >10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year.
CONCLUSION
Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models.
CLINICAL RELEVANCE
Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.
背景
关于术前抑郁对腰椎减压（LD）患者术后心理健康、身体功能和疼痛的影响，现有研究有限。本研究旨在评估通过患者健康问卷-9（PHQ-9）测量的抑郁症状与接受LD手术患者的其他心理健康和身体功能临床结局之间的关联。
方法
回顾2016年3月至2019年5月期间前瞻性维护的原发性LD手术登记资料。患者被分为3个术前PHQ-9评分亚组。PHQ-9评分越高表明抑郁症状越严重。我们通过适当的统计检验评估了亚组之间的人口统计学和围手术期特征。我们还评估了以下结局指标及术后改善情况：PHQ-9、简明健康调查量表12项（SF-12）、退伍军人兰德12项健康调查（VR-12）、患者报告结局测量信息系统身体功能量表（PROMIS-PF）、视觉模拟量表（VAS）腿部疼痛评分和VAS背部疼痛评分。
结果
该队列共351名受试者，男性占70.4%，平均年龄47岁；186名受试者术前抑郁症状轻微（PHQ-9＜5），94名受试者症状中度（5≤PHQ-9≤10），71名受试者症状严重（PHQ-9＞10）。抑郁症状更严重的亚组心理健康结局评分更差（PHQ-9、12项心理健康综合评分[12-MCS]和VR-12心理健康综合评分），且在所有时间点，术前至术后心理健康改善程度呈正线性相关。抑郁症状更严重的亚组在所有时间点的PROMIS-PF评分更差，不过到1年时VAS疼痛评分与抑郁症状无关联。
结论
通过PHQ-9评估，术前抑郁症状更严重的患者，其PHQ-9、SF-12和VR-12评分改善更大，但更严重的PHQ-9评分与更差的总体身体功能评分相关。本研究证明了术前抑郁症状的相关性及其在未来风险因素模型中的必要性。
临床意义
术前PHQ-9的严重程度是术后疼痛以及心理和身体健康改善的重要风险因素。
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