title: The Impact of Preoperative Depression and Health State on Quality-of-Life Outcomes after Anterior Cervical Diskectomy and Fusion.
abstract: Study Design Retrospective cohort study. Objective We sought to assess the predictive value of preoperative depression and health state on 1-year quality-of-life outcomes after anterior cervical diskectomy and fusion (ACDF). Methods We analyzed 106 patients who underwent ACDF. All patients had either bilateral or unilateral cervical radiculopathy. Preoperative and 1-year postoperative health outcomes were assessed based on the visual analog scale, Pain Disability Questionnaire (PDQ), Patient Health Questionnaire (PHQ-9), and EuroQol-5 Dimensions (EQ-5D) questionnaire. Univariable and multivariate regression analyses were performed to assess for preoperative predictors of 1-year change in health status according to the EQ-5D. Results Compared with preoperative health states, the ACDF cohort showed statistically significant improved PDQ (78.5 versus 57.9), PHQ-9 (9.7 versus 5.3), and EQ-5D (0.55 versus 0.68) scores at 1 year postoperatively and surpassed the minimum clinically important difference for the EQ-5D of 0.1 units (all p ≤ 0.01). Multivariate linear regression indicated that anxiolytic use and higher EQ-5D preoperative scores were associated with less 1-year postoperative improvement in health status. Although not statistically significant, clinically important effects of preoperative depression, as measured by the PHQ-9, were observed on postoperative QOL outcome (-0.006, 95% confidence interval -0.014 to 0.001). Conclusions Of patients who undergo ACDF with similar preoperative QOL health states, those with a greater degree of depression may have lower improvements in postoperative QOL compared with those with less depression. Patients with anxiety and better preoperative health states also attain less 1-year QOL improvements.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Neurological Center for Pain, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Judith
authors.initials: J
authors.lastname: Scheman
authors.affiliation: Neurological Center for Pain, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Manu
authors.initials: M
authors.lastname: Mathews
authors.affiliation: Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, Ohio, United States; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, United States; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, United States.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
keywords: ACDF; PHQ-9; cervical fusion; depression; outcomes