1Michigan State College of Human Medicine, Lansing, Michigan.
Departments of2Neurosurgery and.
J Neurosurg Spine. 2024 Mar 1;40(6):741-750. doi: 10.3171/2023.12.SPINE23860. Print 2024 Jun 1.
The presence of depression and anxiety has been associated with negative outcomes in spine surgery patients. While it seems evident that a history of depression or anxiety can negatively influence outcome, the exact additive effect of both has not been extensively studied in a multicenter trial. The purpose of this study was to investigate the relationship between a patient's history of anxiety and depression and their patient-reported outcomes (PROs) after lumbar surgery.
Patients in the Michigan Spine Surgery Improvement Collaborative registry undergoing lumbar spine surgery between July 2016 and December 2021 were grouped into four cohorts: those with a history of anxiety only, those with a history of depression only, those with both, and those with neither. Primary outcomes were achieving the minimal clinically important difference (MCID) for the Patient-Reported Outcomes Measurement Information System Physical Function 4-item Short Form (PROMIS PF), EQ-5D, and numeric rating scale (NRS) back pain and leg pain, and North American Spine Society patient satisfaction. Secondary outcomes included surgical site infection, hospital readmission, and return to the operating room. Multivariate Poisson generalized estimating equation models were used to report incidence rate ratios (IRRs) from patient baseline variables.
Of the 45,565 patients identified, 3941 reported a history of anxiety, 5017 reported a history of depression, 9570 reported both, and 27,037 reported neither. Compared with those who reported having neither, patients with both anxiety and depression had lower patient satisfaction at 90 days (p = 0.002) and 1 year (p = 0.021); PROMIS PF MCID at 90 days (p < 0.001), 1 year (p < 0.001), and 2 years (p = 0.006); EQ-5D MCID at 90 days (p < 0.001), 1 year (p < 0.001), and 2 years (p < 0.001); NRS back pain MCID at 90 days (p < 0.001) and 1 year (p < 0.001); and NRS leg pain MCID at 90 days (p < 0.001), 1 year (p = 0.024), and 2 years (p = 0.027). Patients with anxiety only (p < 0.001), depression only (p < 0.001), or both (p < 0.001) were more likely to be readmitted within 90 days. Additionally, patients with anxiety only (p = 0.015) and both anxiety and depression (p = 0.015) had higher rates of surgical site infection. Patients with anxiety only (p = 0.006) and depression only (p = 0.021) also had higher rates of return to the operating room.
The authors observed an association between a history of anxiety and depression and negative outcome after lumbar spine surgery. In addition, they found an additive effect of a history of both anxiety and depression with an increased risk of negative outcome when compared with either anxiety or depression alone.
抑郁和焦虑的存在与脊柱手术患者的不良结局有关。虽然很明显，抑郁或焦虑的病史可能会对结果产生负面影响，但在多中心试验中，两者的具体附加效应尚未得到广泛研究。本研究的目的是调查患者焦虑和抑郁病史与腰椎手术后患者报告的结果（PROs）之间的关系。
在密歇根州脊柱手术改进合作研究注册中心接受腰椎手术的患者，在 2016 年 7 月至 2021 年 12 月期间被分为四组：仅患有焦虑症的患者、仅患有抑郁症的患者、同时患有两者的患者和两者均无的患者。主要结局是达到患者报告的测量信息系统物理功能 4 项简短形式（PROMIS PF）、EQ-5D 和数字评定量表（NRS）腰背疼痛和腿部疼痛的最小临床重要差异（MCID），以及北美脊柱协会患者满意度。次要结局包括手术部位感染、医院再入院和重返手术室。使用多变量泊松广义估计方程模型报告患者基线变量的发病率比（IRR）。
在确定的 45565 名患者中，3941 名报告有焦虑史，5017 名报告有抑郁史，9570 名报告有两者，27037 名报告两者均无。与未报告有两者的患者相比，同时患有焦虑和抑郁的患者在 90 天（p = 0.002）和 1 年（p = 0.021）时的患者满意度较低；90 天（p < 0.001）、1 年（p < 0.001）和 2 年（p = 0.006）时的 PROMIS PF MCID；90 天（p < 0.001）、1 年（p < 0.001）和 2 年（p < 0.001）时的 EQ-5D MCID；90 天（p < 0.001）和 1 年（p < 0.001）时的 NRS 腰背疼痛 MCID；90 天（p < 0.001）、1 年（p = 0.024）和 2 年（p = 0.027）时的 NRS 腿部疼痛 MCID。仅患有焦虑症的患者（p < 0.001）、仅患有抑郁症的患者（p < 0.001）或两者都有的患者（p < 0.001）在 90 天内再次入院的可能性更高。此外，仅患有焦虑症的患者（p = 0.015）和同时患有焦虑和抑郁症的患者（p = 0.015）的手术部位感染率较高。仅患有焦虑症的患者（p = 0.006）和仅患有抑郁症的患者（p = 0.021）的再次手术率也较高。
作者观察到焦虑和抑郁病史与腰椎手术后不良结局之间存在关联。此外，他们发现，与单独患有焦虑症或抑郁症相比，同时患有焦虑症和抑郁症的病史会增加不良结局的风险。
