title: Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery?
abstract: METHODS
  Longitudinal cohort study.
  
  
  OBJECTIVE
  In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery.
  
  
  BACKGROUND
  Patient satisfaction ratings are increasingly being used in health care as a proxy for quality of care. In the elderly, affective disorders such as depression have been shown to influence patient-reported outcomes and self-interpretation of health status.
  
  
  METHODS
  A total of 69 patients aged 65 years or older undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score, comorbidities, and postoperative satisfaction with surgical care and outcome were assessed for all patients. Baseline and 2-year visual analogue scale (VAS)-leg pain, VAS-back pain, Oswestry Disability Index, Short Form-12 physical component score and Short Form-12 mental component score, as well as health-state utility (EuroQol 5D) were assessed. Factors associated with patient satisfaction after surgical procedures were assessed via multivariate logistic regression analysis.
  
  
  RESULTS
  Compared with baseline, there was a statistically significant improvement in VAS-back pain 2.76±2.73 (pseudarthrosis [1.94±2.81], adjacent segment disease [4.35±3.16]), same-level recurrent stenosis [2±2.23]), VAS-leg pain 2.66±4.12, (adjacent segment disease [2.24±4.46] and same-level recurrent stenosis [3±3.78]). Two-year Oswestry Disability Index improved after surgery for pseudarthrosis (4.05±7.65), adjacent segment disease (6±13.63) and same-level recurrent stenosis (4.54±5.97). In a multivariate logistical regression model, increasing preoperative Zung self-rating depression scale scores were independently associated with patient dissatisfaction 2 years after revision lumbar surgery, (P<0.001).
  
  
  CONCLUSIONS
  This study demonstrates that independent of surgical effectiveness, baseline depression influence patient satisfaction with health care, 2 years after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality of care should account for patients' baseline depression as a potential confounder especially in this age group.
  
  
  METHODS
  3.
authors.affiliation: *Department of Neurosurgery, Duke University Medical Center, Durham, NC †Department of Neurosurgery, University of Texas Health Sciences Center, San Antonio, TX; and ‡Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Kevin
authors.initials: K
authors.lastname: Carr
authors.forename: Parastou
authors.initials: P
authors.lastname: Fatemi
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.forename: Gustavo
authors.initials: G
authors.lastname: Gazcon
authors.forename: Oren
authors.initials: O
authors.lastname: Gottfried
authors.forename: Carlos
authors.initials: C
authors.lastname: Bagley
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng
mesh_terms: D000368:Aged / Q000523:psychology*; D001416:Back Pain / Q000453:epidemiology; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D019299:Decompression, Surgical / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019736:Prostheses and Implants; D011584:Psychology; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation / Q000523:psychology / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D013122:Spinal Diseases / Q000523:psychology / Q000601:surgery; D013123:Spinal Fusion / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome