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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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.
Article Information

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.

© Copyright 1944-2019 American Association of Neurological Surgeons

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References
  • 1

    Adogwa OElsamadicy AAMehta AIVasquez RACheng JKarikari IO: Association between baseline affective disorders and 30-day readmission rates in patients undergoing elective spine surgery. World Neurosurg 94:4324362016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Adogwa OParker SLShau DNMendenhall SKAaronson OSCheng JS: Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 12:1791852012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Alvin MDMiller JALubelski DRosenbaum BPAbdullah KGWhitmore RG: Variations in cost calculations in spine surgery cost-effectiveness research. Neurosurg Focus 36(6):E12014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Asher ALDevin CJArcher KRChotai SParker SLBydon M: An analysis from the Quality Outcomes Database, part 2. Predictive model for return to work after elective surgery for lumbar degenerative disease. J Neurosurg Spine 27:3703812017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Basques BAMcLynn RPFice MPSamuel AMLukasiewicz AMBohl DD: Results of database studies in spine surgery can be influenced by missing data. Clin Orthop Relat Res 475:289329042017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Bekelis KMcGirt MJParker SLHolland CMDavies JDevin CJ: The present and future of quality measures and public reporting in neurosurgery. Neurosurg Focus 39(6):E32015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bernstein DNBrodell DLi YRubery PTMesfin A: Impact of the economic downturn on elective lumbar spine surgery in the United States: a national trend analysis, 2003 to 2013. Global Spine J 7:2132192017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Carley JAKarp JFGentili AMarcum ZAReid MCRodriguez E: Deconstructing chronic low back pain in the older adult: step by step evidence and expert-based recommendations for evaluation and treatment: Part IV: Depression. Pain Med 16:209821082015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Carreon LYDjurasovic MDimar JR IIOwens RK IICrawford CH IIIPuno RM: Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? J Neurosurg Spine 25:3523562016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Chaichana KLMukherjee DAdogwa OCheng JSMcGirt MJ: Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:2612672011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Chang VSchwalb JMNerenz DRPietrantoni LJones SJankowski M: The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative. Neurosurg Focus 39(6):E72015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Elsamadicy AAAdogwa OCheng JBagley C: Pretreatment of depression before cervical spine surgery improves patients’ perception of postoperative health status: a retrospective, single institutional experience. World Neurosurg 87:2142192016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Elsamadicy AAAdogwa OLydon ESergesketter AKaakati RMehta AI: Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery. J Neurosurg Spine 27:2092142017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Falavigna ARighesso OTeles ARConzati LPBossardi JBda Silva PG: Responsiveness of depression and its influence on surgical outcomes of lumbar degenerative diseases. Eur J Orthop Surg Traumatol 25 (Suppl 1):S35S412015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Försth PÓlafsson GCarlsson TFrost ABorgström FFritzell P: A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 374:141314232016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Gandhi SDPatel SAMaltenfort MAnderson DGVaccaro ARAlbert TJ: Patient and surgical factors associated with postoperative urinary retention after lumbar spine surgery. Spine (Phila Pa 1976) 39:190519092014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ghogawala ZDziura JButler WEDai FTerrin NMagge SN: Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:142414342016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Glassman SDCarreon LYDjurasovic MDimar JRJohnson JRPuno RM: Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J 9:13212009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Global Burden of Disease Study 2013 Collaborators: Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386:7438002015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Greenwald ASBassano AWiggins SFroimson MI: Alternative reimbursement models: bundled payment and beyond: AOA critical issues. J Bone Joint Surg Am 98:e452016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Hackbarth GReischauer RMutti A: Collective accountability for medical care—toward bundled Medicare payments. N Engl J Med 359:352008

  • 22

    Hajihasani ARouhani MSalavati MHedayati RKahlaee AH: The influence of cognitive behavioral therapy on pain, quality of life, and depression in patients receiving physical therapy for chronic low back pain: a systematic review. PM R 11:1671762019

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Harrop JSHilibrand AMihalovich KEDettori JRChapman J: Cost-effectiveness of surgical treatment for degenerative spondylolisthesis and spinal stenosis. Spine (Phila Pa 1976) 39 (22 Suppl 1):S75S852014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Henschke NOstelo RWvan Tulder MWVlaeyen JWMorley SAssendelft WJ: Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev (7):CD0020142010

    • Search Google Scholar
    • Export Citation
  • 25

    Hoy DMarch LBrooks PBlyth FWoolf ABain C: The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:9689742014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Hung MSaltzman CLKendall RBounsanga JVoss MWLawrence B: What are the MCIDs for PROMIS, NDI, and ODI instruments among patients with spinal conditions? Clin Orthop Relat Res 476:202720362018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Huysmans EGoudman LVan Belleghem GDe Jaeger MMoens MNijs J: Return to work following surgery for lumbar radiculopathy: a systematic review. Spine J 18:169417142018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Kamper SJApeldoorn ATChiarotto ASmeets RJOstelo RWGuzman J: Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev (9):CD0009632014

    • Search Google Scholar
    • Export Citation
  • 29

    Kroenke KSpitzer RLWilliams JB: The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41:128412922003

  • 30

    Lee DArmaghani SArcher KRBible JShau DKay H: Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am 96:e892014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Maughan EFLewis JS: Outcome measures in chronic low back pain. Eur Spine J 19:148414942010

  • 32

    McGirt MJSivaganesan AAsher ALDevin CJ: Prediction model for outcome after low-back surgery: individualized likelihood of complication, hospital readmission, return to work, and 12-month improvement in functional disability. Neurosurg Focus 39(6):E132015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Murray CJBarber RMForeman KJAbbasoglu Ozgoren AAbd-Allah FAbera SF: Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet 386:214521912015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    O’Connell CAzad TDMittal VVail DJohnson EDesai A: Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes. Neurosurg Focus 44(1):E52018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    O’Donnell JAAnderson JTHaas ARPercy RWoods STAhn UM: Preoperative opioid use is a predictor of poor return to work in workers’ compensation patients after lumbar diskectomy. Spine (Phila Pa 1976) 43:5946022018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Park PNerenz DRAleem ISSchultz LRBazydlo MXiao S: Risk factors associated with 90-day readmissions after degenerative lumbar fusion: an examination of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry. Neurosurgery [epub ahead of print] 2018

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Pincus TBurton AKVogel SField AP: A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976) 27:E109E1202002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Pinheiro MBFerreira MLRefshauge KMaher CGOrdoñana JRAndrade TB: Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J 16:1051162016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Rush AJPolatin PGatchel RJ: Depression and chronic low back pain: establishing priorities in treatment. Spine (Phila Pa 1976) 25:256625712000

  • 40

    Scheer JKOsorio JASmith JSSchwab FHart RAHostin R: Development of a preoperative predictive model for reaching the Oswestry Disability Index minimal clinically important difference for adult spinal deformity patients. Spine Deform 6:5935992018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Sheng JLiu SWang YCui RZhang X: The link between depression and chronic pain: neural mechanisms in the brain. Neural Plast 2017:97243712017

    • Search Google Scholar
    • Export Citation
  • 42

    Soroceanu ABurton DCOren JHSmith JSHostin RShaffrey CI: Medical complications after adult spinal deformity surgery: incidence, risk factors, and clinical impact. Spine (Phila Pa 1976) 41:171817232016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Spitzer RLKroenke KWilliams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 282:1737–17441999

    • Search Google Scholar
    • Export Citation
  • 44

    Tsuji TMatsudaira KSato HVietri J: The impact of depression among chronic low back pain patients in Japan. BMC Musculoskelet Disord 17:4472016

  • 45

    Wadhwa RKOhya JVogel TDCarreon LYAsher ALKnightly JJ: Risk factors for 30-day reoperation and 3-month readmission: analysis from the Quality and Outcomes Database lumbar spine registry. J Neurosurg Spine 27:1311362017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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