are preoperative phq-9 scores predictive of postoperative
TRANSCRIPT
Are Preoperative PHQ-9 Scores Predictive of Postoperative Outcomes Improvement Following
Anterior Cervical Discectomy and Fusion?
James M. Parrish, MPH1; Nathaniel W. Jenkins, MS1; Nadia Hrynewycz, BS1; Thomas Brundage, BS1; Joon Yoo, BA1; Kern Singh1,2
1Department of Orthopaedic Surgery, Rush University Medical Center2Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center;
Founder and President, Minimally Invasive Spine Study Group
DisclosuresNathaniel W. Jenkins, MS; James M. Parrish, MPH; Nadia Hrynewycz, BS; Thomas Brundage, BS; Joon Yoo, BA Nothing to disclose
Kern Singh, MD
• Royalties – Zimmer Biomet, Stryker K2M, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, Slack Publishing
• Stock Ownership - TDi, LLC and Vital 5, LLC.• Consulting - Zimmer Biomet, Stryker K2M• Board Membership – Vital 5 LLC, TDi LLC, Minimally Invasive Spine Study Group• Editorial Board - Contemporary Spine Surgery, Orthopedics Today, Vertebral Columns• Board of Directors / Committee Membership - CSRS, ISASS, AAOS• Grants - Cervical Spine Research Society
Introduction
• The Patient Health Questionnaire-9 (PHQ-9) • widely used depression screening tool
• Preoperative depression & anxiety predict postop pain and physical impairments
Aims and Objectives
Purpose: ● Assess possible association between:
○ preoperative depression■ quantified by PHQ-9,
○ postoperative improvement in pain and disability after an ACDF.
Methodology
● Prospectively-maintained registry, retrospective review
● 119 patients that underwent:○ Primary,○ 1, 2, or 3 level○ degenerative spondylolisthesis
Methodology
• Variables Analyzed• Patient Health-Questionnaire-9
(PHQ9), • Visual Analogue Scale (VAS) neck
and arm pain, • Oswestry Disability Index (ODI),• 12-Item Short Form Physical
Component Score (SF-12 PCS)
• Statistical Analyses• Pairwise comparisons• Linear regression
■ PRO scores analyzed■ Among other PRO scores
• MCID was compared■ Chi-Squared analysis
Higher PHQ-9 = ↑ preoperative NDI, VAS neck pain, and VAS arm pain scores↓ preoperative SF-12 PCS scores
Same Scores at 1-year follow-up
Results● High PHQ-9 cohort:
○ Greater percent achieved MCID for NDI
● No differences in MCID achievement for:
○ VAS neck pain○ VAS arm pain ○ SF-12 PCS
Discussion
● Patients with worse preoperative mental health:○ Greater preoperative disability and pain○ However, significant long-term improvements in
PROs following ACDF● Patients can expect to have similar 1-year follow-up
clinical outcomes regardless of preoperative PHQ-9 score
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