High Depressive Burden as a Predictor of Worse Patient-Reported Outcome Measures and Increased Revision Rates After Lumbar Fusion.

OBJECTIVE

The aim of this study was to investigate the effect of high "depressive burden" on patient-reported outcome measures (PROMs) after lumbar fusion surgery.

METHODS

Adult patients who underwent elective 1-3 level lumbar fusion at a single institution (2017 to 2023) were identified. PROMs included Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) Back and Leg, Mental Component Summary (MCS), and Physical Component Summary (PCS). High depressive burden was defined as an average preoperative and 3-month postoperative MCS score below 45, a threshold used in the psychiatry literature to indicate depression requiring intervention. PROMs and minimal clinically important difference (MCID) were compared between patients with and without high depressive burden.

RESULTS

A total of 418 patients were included (127 [30.4%] had high depressive burden). Patients with high depressive burden were younger (60.6 vs. 63.9 years; P = 0.004) and more commonly Black (13.7% vs. 5.94%; P = 0.031) compared with patients without high depressive burden-otherwise, the two groups were demographically similar. Patients with high depressive burden had longer cut-to-close times (240 vs. 215 minutes; P = 0.031) but otherwise were surgically similar. High depressive burden was associated with a higher 2-year revision surgery rate (13.4% vs. 5.15%; P = 0.007). High depressive burden was associated with worse scores for all PROMs at 6 months and 1 year postoperatively. Multivariable regression identified depressive burden as independently predictive of a decreased likelihood of achieving MCID for 1-year ODI (odds ratio [OR]: 0.19; P < 0.001) and PCS (OR: 0.35; P = 0.002) and of requiring revision surgery within 2 years (OR: 2.98; P = 0.006).

CONCLUSIONS

High depressive burden provides a more robust measurement of mental health in the preoperative and early postoperative period. High depressive burden was associated with a higher 2-year revision surgery rate and worse performance on all PROMs at 6 months and 1 year. High depressive burden was also independently predictive of decreased likelihood of achieving MCID for ODI and PCS at 1 year and of requiring revision surgery within 2 years.