title: The impact of preoperative depression on quality of life outcomes after lumbar surgery.
abstract: BACKGROUND
  Some, smaller studies have investigated the effect of preoperative depression on postoperative improvement in quality of life (QOL). However, they have not used the Patient Health Questionnaire 9 (PHQ-9) in self-reported depression.
  
  
  OBJECTIVE
  To assess the effect of preoperative depression as measured by the PHQ-9 on postoperative improvement in QOL.
  
  
  METHODS
  A retrospective review at a single tertiary-care referral center.
  
  
  METHODS
  Patients who underwent lumbar decompression or fusion between 2008 and 2012.
  
  
  METHODS
  A self-reported EuroQol five-dimensions (EQ-5D) quality-adjusted life-years Index.
  
  
  METHODS
  Quality of life data were collected using the institutional prospectively collected database of patient-reported health status measures. The EQ-5D questionnare, PDQ, and PHQ-9 were used. Linear and logistic regression analyses were performed to assess the impact of preoperative depression on QOL improvement.
  
  
  RESULTS
  Elevated preoperative pain (PDQ, β=-0.0017, p=.0009) and worsened depression (PHQ-9, β=-0.0044, p=.0359) were significantly associated with diminished postoperative improvement in QOL, as measured by the EQ-5D. Furthermore, greater depression (PHQ-9, odds ratio [OR] 0.93, p<.0001) and pain (PDQ, OR 0.99, p=.02) were associated with significantly diminished postoperative improvement exceeding the minimum clinically important difference.
  
  
  CONCLUSIONS
  Increased preoperative pain and depression were shown to be associated with significantly reduced improvement in postoperative QOL, as measured by the EQ-5D.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA.
authors.forename: Adeeb
authors.initials: A
authors.lastname: Derakhshan
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.affiliation: Carolina Neurosurgery and Spine Associates, 225 Baldwin Ave., Charlotte, NC 28204, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., NA41, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S40, Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D000368:Aged; D001416:Back Pain / Q000523:psychology* / Q000601:surgery; D019299:Decompression, Surgical / Q000523:psychology*; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011184:Postoperative Period; D057234:Preoperative Period; D011788:Quality of Life / Q000523:psychology*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Depression; EQ-5D; Lumbar surgery; PDQ; PHQ-9; Psychosocial outcomes