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Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery?

Publication ,  Journal Article
Adogwa, O; Carr, K; Fatemi, P; Verla, T; Gazcon, G; Gottfried, O; Bagley, C; Cheng, J
Published in: Spine (Phila Pa 1976)
September 1, 2014

STUDY DESIGN: Longitudinal cohort study. OBJECTIVE: In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery. SUMMARY OF BACKGROUND DATA: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

September 1, 2014

Volume

39

Issue

19

Start / End Page

1614 / 1619

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Spinal Fusion
  • Spinal Diseases
  • Smoking
  • Reoperation
  • Recurrence
  • Recovery of Function
  • Psychology
  • Prostheses and Implants
 

Citation

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Adogwa, O., Carr, K., Fatemi, P., Verla, T., Gazcon, G., Gottfried, O., … Cheng, J. (2014). Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976), 39(19), 1614–1619. https://doi.org/10.1097/BRS.0000000000000474
Adogwa, Owoicho, Kevin Carr, Parastou Fatemi, Terence Verla, Gustavo Gazcon, Oren Gottfried, Carlos Bagley, and Joseph Cheng. “Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery?Spine (Phila Pa 1976) 39, no. 19 (September 1, 2014): 1614–19. https://doi.org/10.1097/BRS.0000000000000474.
Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, et al. Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976). 2014 Sep 1;39(19):1614–9.
Adogwa, Owoicho, et al. “Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery?Spine (Phila Pa 1976), vol. 39, no. 19, Sept. 2014, pp. 1614–19. Pubmed, doi:10.1097/BRS.0000000000000474.
Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, Bagley C, Cheng J. Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976). 2014 Sep 1;39(19):1614–1619.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

September 1, 2014

Volume

39

Issue

19

Start / End Page

1614 / 1619

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surveys and Questionnaires
  • Spinal Fusion
  • Spinal Diseases
  • Smoking
  • Reoperation
  • Recurrence
  • Recovery of Function
  • Psychology
  • Prostheses and Implants