Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative

Presented at the 2019 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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  • 1 Department of Neurosurgery,
  • 2 Center for Health Services Research, and
  • 3 Department of Public Health Sciences, Henry Ford Hospital, Detroit; and
  • 4 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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OBJECTIVE

The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire–2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion.

METHODS

Data from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is ≥ 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage.

RESULTS

Multivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion.

CONCLUSIONS

A multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.

ABBREVIATIONS ADD = any depressive disorder; ASA = American Society of Anesthesiologists; BCBSM = Blue Cross Blue Shield of Michigan; CAD = coronary artery disease; DVT = deep vein thrombosis; LOS = length of stay; MCID = minimal clinically important difference; MDD = major depressive disorder; MSSIC = Michigan Spine Surgery Improvement Collaborative; ODI = Oswestry Disability Index; PHQ-2 = Patient Health Questionnaire–2; PRO = patient-reported outcome; RR = relative risk.

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Contributor Notes

Correspondence Victor Chang: Henry Ford West Bloomfield Hospital, West Bloomfield Township, MI. vchang1@hfhs.org.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.6.SPINE1963.

Disclosures Dr. Abdulhak reports being a consultant for SeaSpine and ulrich medical USA; he also reports receiving clinical or research support from BCBSM for the present study. Dr. Schwalb reports receiving salary support from BCBSM for being codirector of MSSIC. Dr. Park reports being a consultant for Globus Medical, NuVasive, AlloSource, and Medtronic; he receives royalties from Globus Medical and support of non–study-related clinical or research efforts that he oversees from Pfizer. Dr. Chang reports being a consultant for Globus Medical, K2M, and SpineGuard; he has received support of non–study-related clinical or research efforts that he oversees from Medtronic.

Although BCBSM and MSSIC work collaboratively, the opinions, beliefs, and viewpoints expressed by the authors do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program.

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