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Mariaux F, Elfering A, Fekete TF, Porchet F, Haschtmann D, Reitmeir R, Loibl M, Jeszenszky D, Kleinstück FS, Mannion AF. The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2269-2276. [PMID: 38642136 DOI: 10.1007/s00586-024-08190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery. METHODS Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12 months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling. RESULTS From 731 eligible patients, 547 (61.0 ± 12.5 years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3 months' FU in men (β = 0.36) and 12 months' FU in men and women (both β = 0.20) (all p < 0.001). CONCLUSION The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.
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Affiliation(s)
- Francine Mariaux
- Department of Teaching, Research and Development, Spine Centre Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Achim Elfering
- Institute for Psychology, University of Bern, Bern, Switzerland
| | | | | | | | | | - Markus Loibl
- Spine Centre, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Anne F Mannion
- Department of Teaching, Research and Development, Spine Centre Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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Nie JW, Hartman TJ, Oyetayo OO, Zheng E, MacGregor KR, Anwar FN, Roca AM, Federico VP, Massel DH, Lopez GD, Sayari AJ, Singh K. Effect of Baseline Veterans RAND-12 Mental Composite Score on Postoperative Patient-Reported Outcome Measures for Cervical Disk Replacement. Clin Spine Surg 2024; 37:E147-E151. [PMID: 38178315 DOI: 10.1097/bsd.0000000000001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/03/2023] [Indexed: 01/06/2024]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To examine the effect of baseline Veterans RAND-12 (VR-12) Mental Composite Score (MCS) on clinical outcomes in patients undergoing cervical disk replacement (CDR) for herniated disk. BACKGROUND Few studies in spine surgery have evaluated the impact of preoperative VR-12 MCS on postoperative outcomes in patients undergoing CDR. METHODS Patients undergoing CDR for herniated disk were separated into 2 cohorts based on the VR-12 MCS standardized mean: VR-12 MCS<50 (worse mental health) and VR-12 MCS≥50 (better mental health). Patient-reported outcome measures of VR-12 MCS, VR-12 Physical Composite Score, Short Form-12 (SF-12) MCS, SF-12 Physical Composite Score, Patient-Reported Outcomes Measurement Information System Physical Function, Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Neck Pain, VAS Arm Pain, and Neck Disability Index were collected at preoperative and up to 2-year postoperative time points. RESULTS In all, 109 patients were identified, with 50 patients in the worse mental health cohort. The worse mental health cohort reported inferior patient-reported outcome measures in all domains at preoperative, 6-week postoperative, and final postoperative time points. For 6-week postoperative improvement, the worse mental health cohort reported greater improvement for VR-12 MCS, SF-12 MCS, and PHQ-9. For final postoperative improvement, the worse mental health cohort reported greater improvement in VR-12 MCS and SF-12 MCS. Minimum clinically important difference achievement rates were higher in the worse mental health cohort for VR-12 MCS, SF-12 MCS, and PHQ-9. CONCLUSION Patients undergoing cervical disk replacement for herniated disk with worse baseline mental health reported inferior clinical outcomes in mental health, physical function, pain, and disability outcomes throughout the postoperative period. Patients with worse baseline mental health demonstrated greater clinically meaningful improvement in mental health. In cervical disk replacement patients, those with worse baseline mental health may report inferior postoperative clinical outcomes but experience greater rates of tangible improvement in mental health.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Sang D, Xiao B, Rong T, Wu B, Cui W, Zhang J, Zhang Y, Liu B. Depression and anxiety in cervical degenerative disc disease: Who are susceptible? Front Public Health 2023; 10:1002837. [PMID: 36684946 PMCID: PMC9853204 DOI: 10.3389/fpubh.2022.1002837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Pre-operative depression and anxiety are associated with poorer patient-reported outcomes following cervical spine surgery. Identification of and interventions for these disorders are key to preventing related negative effects. However, most spine surgeons do not routinely evaluate mental health disorders. Few studies have investigated which patients with cervical degenerative disc diseases (CDDD) are susceptible to depression and anxiety. Objective To determine the factors associated with depression and anxiety in patients with CDDD. Methods Three hundred twelve patients with CDDD were recruited in this cross-sectional case-control study. Patients underwent a structured interview to acquire demographic and clinical characteristic information, which included the Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA), and Visual Analog Scale (VAS) for neck/arm pain. Depression and anxiety were evaluated using the Zung Self-Rating Depression and Anxiety Scales. Univariate and multivariate logistic regression analyses were used to identify factors associated with depression and anxiety. Results Of all patients, 102 (32.7%) had depression and 92 (29.5%) had anxiety. Two hundred six (66.0%) patients with neither depression nor anxiety were defined as the control group. Univariate analysis indicated that gender, educational level, occupation type, Charlson comorbidity index, symptom duration, symptomatology, surgery history, NDI, mJOA, VAS-neck, and VAS-arm scores were associated with depression and anxiety (except for symptom duration for anxiety). Multivariate logistic regression analysis indicated that females [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.01-3.23], physical work (OR 2.06, 95% CI 1.16-3.65), poor mJOA score (ORmoderate 2.67, 95% CI 1.40-5.07; ORsevere 7.63, 95% CI 3.85-15.11), and high VAS-neck score (OR 1.24, 95% CI 1.11-1.39) were independent risk factors for depression. Physical work (OR 1.84, 95% CI 1.01-3.35), poor mJOA score (ORmoderate 2.66, 95% CI 1.33-5.33; ORsevere 9.26, 95% CI 4.52-18.99), and high VAS-neck score (OR 1.34, 95% CI 1.19-1.51) were independent risk factors for anxiety. Conclusion Approximately one-third of patients with CDDD had depression or anxiety. Patients who engaged in heavy work and had severe symptoms (poor mJOA and high VAS-neck scores) are susceptible to depression and anxiety. Additionally, female patients are susceptible to depression. Our findings may help identify CDDD patients with depression and anxiety in clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hartman TJ, Nie JW, MacGregor KR, Oyetayo OO, Zheng E, Singh K. Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion. J Clin Orthop Trauma 2022; 34:102020. [PMID: 36161064 PMCID: PMC9490096 DOI: 10.1016/j.jcot.2022.102020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 09/07/2022] [Indexed: 10/31/2022] Open
Abstract
Background Mental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population. Methods WC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. Results Depressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all). Conclusion Depressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.
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Affiliation(s)
- Timothy J. Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James W. Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R. MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O. Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
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Dual Role of Neck Disability Index in the Assessment of Quality of Life in Cervical Spine Patients. J Am Acad Orthop Surg 2022; 30:e789-e798. [PMID: 35191853 DOI: 10.5435/jaaos-d-20-01192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The Neck Disability Index (NDI) is a well-established measure for patients with cervical myelopathy, radiculopathy, or myeloradiculopathy. Few studies have examined the relationship between NDI and mental health outcomes after anterior cervical diskectomy and fusion (ACDF). Our study sets out to determine the possible correlations between NDI and mental health outcome measures after ACDF. METHODS A prospectively maintained surgical registry was retrospectively reviewed for elective ACDF procedures from December 2013 to December 2019. Demographic and perioperative characteristics were collected. Primary outcomes of interest were NDI, 12-Item Short Form Mental Component Summary (SF-12 MCS), and Patient Health Questionnaire-9 (PHQ-9). Outcomes were collected preoperatively and postoperatively (6 weeks, 12 weeks, 6 months, 1 year, and 2 years). Postoperative improvement for all outcomes was evaluated using a paired Student t-test. Correlations between NDI and mental health outcomes were evaluated using the Pearson correlation coefficient. Strength of association was determined using the following criteria: weak (0.1 ≤ |r| < 0.3), moderate (0.3 ≤ |r| < 0.5), and strong (|r| ≥ 0.5). RESULTS A total of 225 patients were included in this study. Most of the patients underwent a single-level procedure and had a spinal pathology of herniated nucleus pulposus. NDI demonstrated significant improvements through 2 years compared with preoperative values (all P < 0.001). Similarly, SF-12 MCS and PHQ-9 significantly improved through 1-year postoperatively (all P ≤ 0.010) but was not maintained at 2 years (P = 0.835; P = 0.128). NDI demonstrated a significant but moderate correlation with SF-12 MCS at the preoperative time point, but a strong correlation was observed at all postoperative time points (all P ≤ 0.001). A significant and strong correlation between NDI and PHQ-9 was demonstrated at all time points (all P ≤ 0.002). DISCUSSION NDI demonstrated notable and strong correlations with mental health outcome measures at all postoperative time points. NDI is an effective measure to assess neck disability but may also help capture changes to mental health symptoms after ACDF.
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Chen J, Li JY, Tian GH, Qiu RJ, Zhao XQ, Di XS, Yuan QM, Long SW, Ran Y, Jia YS, Shang HC. A national snapshot of the impact of clinical depression on post-surgical pain and adverse outcomes after anterior cervical discectomy and fusion for cervical myelopathy and radiculopathy: 10-year results from the US Nationwide Inpatient Sample. PLoS One 2021; 16:e0258517. [PMID: 34653189 PMCID: PMC8519476 DOI: 10.1371/journal.pone.0258517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 12/27/2022] Open
Abstract
Depression is associated with poorer outcomes in a wide spectrum of surgeries but the specific effects of depression in patients undergoing cervical spine surgery are unknown. This study aimed to evaluate the prevalence and impact of pre-surgical clinical depression on pain and other outcomes after surgery for cervical degenerative disc disease using a national representative database. Data of patients with cervical myelopathy and radiculopathy were extracted from the 2005–2014 US Nationwide Inpatient Sample (NIS) database. Included patients underwent anterior discectomy and fusion (ACDF). Acute or chronic post-surgical pain, postoperative complications, unfavorable discharge, length of stay (LOS) and hospital costs were evaluated. Totally 215,684 patients were included. Pre-surgical depression was found in 29,889 (13.86%) patients, with a prevalence nearly doubled during 2005–2014 in the US. Depression was independently associated with acute or chronic post-surgical pain (aOR: 1.432), unfavorable discharge (aOR: 1.311), prolonged LOS (aOR: 1.152), any complication (aOR: 1.232), respiratory complications/pneumonia (aOR: 1.153), dysphagia (aOR: 1.105), bleeding (aOR: 1.085), infection/sepsis (aOR: 1.529), and higher hospital costs (beta: 1080.640) compared to non-depression. No significant risk of delirium or venous thrombotic events was observed in patients with depression as compared to non-depression. Among patients receiving primary surgery, depression was independently associated with prolonged LOS (aOR: 1.150), any complication (aOR:1.233) and postoperative pain (aOR:1.927). In revision surgery, no significant associations were found for prolonged LOS, any complication or pain. In conclusion, in the US patients undergoing ACDF, pre-surgical clinical depression predicts post-surgical acute or chronic pain, a slightly prolonged LOS and the presence of any complication. Awareness of these associations may help clinicians stratify risk preoperatively and optimize patient care.
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Affiliation(s)
- Jiang Chen
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Yu Li
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Gui-Hua Tian
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rui-Jin Qiu
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Qian Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Shi Di
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiao-Mei Yuan
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shui-Wen Long
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Ran
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Song Jia
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Cai Shang
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Cushnie D, Fisher C, Hall H, Johnson M, Christie S, Bailey C, Phan P, Abraham E, Glennie A, Jacobs B, Paquet J, Thomas K. Mental health improvements after elective spine surgery: a Canadian Spine Outcome Research Network (CSORN) study. Spine J 2021; 21:1332-1339. [PMID: 33831545 DOI: 10.1016/j.spinee.2021.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/19/2021] [Accepted: 03/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spine patients have a higher rate of depression then the general population which may be caused in part by levels of pain and disability from their spinal disease. PURPOSE Determination whether improvements in health-related quality of life (HRQOL) resulting from successful spine surgery leads to improvements in mental health. STUDY DESIGN/SETTING The Canadian Spine Outcome Research Network prospective surgical outcome registry. OUTCOME MEASURES Change between preoperative and postoperative SF12 Mental Component Score (MCS). Secondary outcomes include European Quality of Life (EuroQoL) Healthstate, SF-12 Physical Component Score (PCS), Oswestry Disability Index (ODI), Patient Health Questionaire-9 (PHQ9), and pain scales. METHODS The Canadian Spine Outcome Research Network registry was queried for all patients receiving surgery for degenerative thoracolumbar spine disease. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement in postoperative disability (ODI) and secondary measures. Multivariate analysis examined factors predictive of MCS improvement. RESULTS Eighteen hospitals contributed 3222 eligible patients. Worse ODI, EuroQoL, PCS, back pain and leg pain correlated with worse MCS at all time points. Overall, patients had an improvement in MCS that occurred within 3 months of surgery and was still present 24 months after surgery. Patients exceeding Minimally Clinically Important Differences in ODI had the greatest improvements in MCS. Major depression prevalence decreased up to 48% following surgery, depending on spine diagnosis. CONCLUSIONS Large scale, real world, registry data suggests that successful surgery for degenerative lumbar disease is associated with reduction in the prevalence of major depression regardless of the specific underlaying diagnosis. Worse baseline MCS was associated with worse baseline HRQOL and improved postoperatively with coincident improvement in disability, emphasizing that mental wellness is not a static state but may improve with well-planned spine surgery.
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Affiliation(s)
- D Cushnie
- McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8.
| | - C Fisher
- University of British Columbia, 6th floor, 818 West 10th Avenue, Vancouver, British Columbia, Canada, V5Z 1M9
| | - H Hall
- University of Toronto, 494851 Traverston Road, Markdale, Ontario, Canada, N0C 1H0
| | - M Johnson
- University of Manitoba, AD401 - 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9
| | - S Christie
- Dalhousie University, Department of Surgery (Neurosurgery), Halifax, Nova Scotia, Canada, B3H 4R2
| | - C Bailey
- Western University, 800 Commissioners Rd. E., E1-317London, Ontario, Canada, N6A 5W9
| | - P Phan
- University of Ottawa, 1053 Carling Ave, Ottawa, Ontario, Canada, K1Y 4E9
| | - E Abraham
- Dalhousie University, 555 Somerset St, Suite 200, Saint John, New Brunswick, Canada, E2K 4X2
| | - A Glennie
- Dalhousie University, Department of Surgery (Neurosurgery), Halifax, Nova Scotia, Canada, B3H 4R2
| | - B Jacobs
- University of Calgary, Foothills Medical Centre, 1403 - 29th Street NW Calgary, AB, Canada T2N 2T9
| | - J Paquet
- CHU de Québec-Université Laval, 1401 18e rue, Québec City, Quebec, Canada, G1J 1Z4
| | - K Thomas
- University of Calgary, Foothills Medical Centre, 1403 - 29th Street NW Calgary, AB, Canada T2N 2T9
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Goh GS, Thever Y, Tay AYW, Rikhraj IS, Koo K. Can patients with psychological distress achieve comparable functional outcomes and satisfaction after hallux valgus surgery? A 2-year follow-up study. Foot Ankle Surg 2021; 27:660-664. [PMID: 32917525 DOI: 10.1016/j.fas.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the influence of preoperative mental health on functional outcomes and satisfaction, and the change in mental health after hallux valgus surgery. METHODS 383 patients who underwent scarf osteotomy were analyzed. Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society score (AOFAS) and SF-36 were assessed at 6 months and 2 years. The cohort was stratified into patients with and without psychological distress (i.e. SF-36 Mental Component Summary [MCS] <50 vs ≥50). RESULTS After adjusting for demographics and baseline scores, VAS and AOFAS were poorer in the distressed group at 6 months. However, there was no difference in scores at 2 years and a similar proportion of patients were satisfied. SF-36 MCS in distressed patients significantly improved, but remained lower compared to non-distressed patients at follow-up. CONCLUSIONS Patients with psychological distress undergoing hallux valgus surgery had poorer short-term outcomes, but these differences resolved at 2 years.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Predictors of Outcomes After Single-level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy: A Multivariate Analysis. Clin Spine Surg 2020; 33:E525-E532. [PMID: 32349058 DOI: 10.1097/bsd.0000000000000997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY DESIGN This was a retrospective study that was carried out using prospectively collected registry data. OBJECTIVE The objective of this study was to identify preoperative predictors of outcomes after anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA Proper patient selection is paramount to achieving good surgical results. Identifying predictors of outcomes may aid surgical decision-making and facilitate counseling of patients to manage expectations. METHODS Prospectively collected registry data of 104 patients who underwent single-level ACDF for cervical spondylotic myelopathy were reviewed. Outcomes assessed at 2 years were the presence of residual neck pain/arm pain (AP), and attainment of a minimal clinically important difference (MCID) for Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and Physical Component Score (PCS) of SF-36, as well as patient satisfaction, fulfilment of expectations, willingness to undergo same surgery again, return to work (RTW), and return to function (RTF). Receiver operating characteristic curves and multivariate stepwise logistical regression were performed to identify independent predictors of each outcome using 22 covariates including demographics, comorbidities, and preoperative disease state. RESULTS Lower preoperative NDI was predictive of the absence of residual neck pain/AP at 2 years. Higher preoperative JOA score was predictive of MCID attainment for PCS, satisfaction, expectation fulfilment, willingness to undergo the same surgery for same condition, and RTF. Poorer preoperative scores of NDI, JOA, and PCS were predictors of attaining MCID of the respective scores. Older patients were less likely to attain MCID for JOA. Higher preoperative AP was a risk factor for unsuccessful RTW. CONCLUSIONS In general, the preoperative JOA score was the best predictor of outcomes after ACDF. A preoperative JOA cutoff value of 9.25-10.25 predicted satisfaction, expectation fulfilment, willingness to undergo same surgery, and RTF with at least 70% sensitivity and 50% specificity. These findings may aid surgeons in identifying patients at risk of a poor outcome and guide preoperative counseling to establish realistic expectations of the surgical outcome. LEVEL OF EVIDENCE Level III-Non-randomized controlled cohort/follow-up study.
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Ten-Year Results of Unicompartmental Knee Arthroplasty in Patients With Psychological Distress. J Arthroplasty 2020; 35:2830-2836.e1. [PMID: 32475784 DOI: 10.1016/j.arth.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/18/2020] [Accepted: 05/04/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although the influence of psychological distress on the outcomes of total knee arthroplasty has been described extensively, its effect on unicompartmental knee arthroplasty (UKA) is poorly defined. Furthermore, most studies in arthroplasty literature had short follow-ups of ≤1 year. We investigated the influence of psychological distress on long-term patient-reported outcomes and analyzed the change in mental health after UKA in a cohort with minimum 10 years of follow-up. METHODS Prospectively collected data of 269 patients undergoing UKA in 2004-2007 were reviewed. Patients were stratified into those with psychological distress (36-item Short-Form health survey [SF-36] Mental Component Summary [MCS] <50, n = 111) and those without (SF-36 MCS ≥50, n = 158). Clinical outcomes were obtained preoperatively, at 2 years, and 10 years. Multiple regression was used to control for age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, and baseline scores. The rate of expectation fulfillment and satisfaction was compared. RESULTS Psychologically distressed patients had poorer Knee Society Knee Score, Function Score, Oxford Knee Score, and SF-36 Physical Component Summary preoperatively, at 2 years, and 10 years. However, an equal proportion in each group attained the minimal clinically important difference for each score. Distressed patients had a comparable rate of satisfaction (91% vs 95%, P = .136) but lower fulfillment of expectations (89% vs 95%, P = .048). The percentage of distressed patients declined from 41% to 35% at follow-up. The mean SF-36 MCS improved by 6.9 points. CONCLUSION Although psychologically distressed patients had relatively greater pain and poorer function preoperatively and up to 10 years after UKA, a similar proportion of them experienced a clinically meaningful improvement in patient-reported outcomes.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Harris AB, Marrache M, Puvanesarajah V, Raad M, Jain A, Kebaish KM, Riley LH, Skolasky RL. Are preoperative depression and anxiety associated with patient-reported outcomes, health care payments, and opioid use after anterior discectomy and fusion? Spine J 2020; 20:1167-1175. [PMID: 32179156 DOI: 10.1016/j.spinee.2020.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Depression and anxiety are common psychiatric conditions among US adults, and anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal surgeries. Mental health conditions can affect physical health, and thus have the potential to contribute to adverse outcomes after spine surgery; however, a comprehensive assessment of long-term outcomes and the additive economic burden of these conditions in patients undergoing ACDF has not been well described. PURPOSE Our goal was to assess the associations between depression/anxiety and adverse outcomes and health-resource utilization after anterior cervical discectomy and fusion (ACDF). STUDY DESIGN Retrospective database study. PATIENT SAMPLE We retrospectively analyzed a private administrative health claims database to identify patients who underwent ACDF in the United States from 2010 to 2013. A total of 16,306 patients met our inclusion criteria. Mean (± standard deviation) patient age was 50±7.9 years. Approximately 4,800 patients (30%) had a depression diagnosis and 4,000 (25%) had a diagnosis of anxiety. OUTCOME MEASURES The primary outcomes of interest were intensive care unit admission, multiday hospitalization, discharge disposition, 30- and 90-day hospital readmission, 1- and 2-year rates of revision surgery, and chronic postoperative opioid use. Secondary outcomes were 1- and 2-year total cumulative health care payments and cumulative postoperative opioid consumption. METHODS Regression models controlled for demographic and medical covariates, alpha=0.05. RESULTS A preoperative diagnosis of depression was associated with higher odds of multiday hospitalization (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01-1.19), 90-day readmission (OR 1.71, 95% CI 1.46-2.02), revision surgery within 2 years (OR 1.43 95% CI 1.16-1.76), and chronic postoperative opioid use (OR 1.58, 95% CI 1.45-1.72) and an increase of $5,915 in adjusted 2-year health care payments (p<.001). Patients with a preoperative diagnosis of anxiety had higher odds of multiday hospitalization (OR 1.15, 95% CI 1.06-1.25), revision surgery within 2 years (OR 1.33, 95% CI 1.07-1.65), and chronic postoperative opioid use (OR 1.62, 95% CI 1.48-1.77) and an increase of $4,471 in adjusted 2-year health care payments (p<.001). Neither anxiety nor depression was associated with intensive care unit admission, discharge disposition, 30-day readmission, revision surgery within 1 year, 1-year cumulative health care payments, or cumulative postoperative opioid consumption. CONCLUSIONS Patients with preoperative diagnoses of depression or anxiety have a greater likelihood of adverse outcomes, increased opioid consumption, and increased cumulative health care payments after ACDF compared with patients without depression or anxiety.
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Affiliation(s)
- Andrew B Harris
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Majd Marrache
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Khaled M Kebaish
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Lee H Riley
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Richard L Skolasky
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Lin YH, Chen HC, Hsu NW, Chou P. Validation of Global Self-Rated Health and Happiness Measures Among Older People in the Yilan Study, Taiwan. Front Public Health 2020; 8:346. [PMID: 32850586 PMCID: PMC7411153 DOI: 10.3389/fpubh.2020.00346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Single-item measures of physical and mental health are feasible for older adults, but their validity for that age group is unclear. This study tested validity of a global self-rated health and a global self-rated happiness measure in a large sample of community-dwelling older adults in Taiwan. Methods: A cross-sectional sample of 3,982 men and women aged 65 or older in Yilan, Taiwan, provided data on global self-rated health and happiness using 100-point numerical scales. The Physical Component Summary of the 12-Item Short Form Health Survey (version 2) and the Groningen Activity Restriction Scale were used to test the validity of the self-rated health item. The Mental Component of that 12-item scale and the Hospital Anxiety and Depression Scale were validators regarding the self-rated happiness item. Criterion validity was tested using the 12-Item Short Form Health Survey (version 2). Results: The correlations between the self-rated health and happiness measures and the 12-Item Short Form Health Survey (version 2) validators were positive and statistically significant, supporting convergent validity. Sufficient divergent validity was demonstrated through the negative and significant relationship between the self-rated health item and the Groningen Activity Restriction Scale scores and the negative and significant relationship between the self-rated happiness item and the Hospital Anxiety and Depression Scale. Optimal cut-off scores for physical and mental health states depended on age and gender. Conclusion: The global self-rated health and happiness measures were validated. Cut-off scores for evaluating older adults' physical and mental health should be age- and gender-specific.
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Affiliation(s)
- Yen-Huai Lin
- Department of Medical Imaging, Cheng Hsin General Hospital, Taipei, Taiwan.,Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry and Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Wei Hsu
- Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Public Health Bureau, Yilan, Taiwan
| | - Pesus Chou
- Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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Doi T, Nakamoto H, Nakajima K, Hirai S, Sato Y, Kato S, Taniguchi Y, Matsubayashi Y, Matsudaira K, Takeshita K, Tanaka S, Oshima Y. Effect of depression and anxiety on health-related quality of life outcomes and patient satisfaction after surgery for cervical compressive myelopathy. J Neurosurg Spine 2019; 31:816-823. [PMID: 31518976 DOI: 10.3171/2019.6.spine19569] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Preoperative mood disorders such as depression and anxiety are known to be associated with poor health-related quality of life (HRQOL) outcomes after lumbar spine surgery. However, the effects of preoperative depression and anxiety on postoperative HRQOL outcomes and patient satisfaction in cervical compressive myelopathy are yet to be clarified. This study aimed to investigate the effect of depression and anxiety on HRQOL outcomes and patient satisfaction following surgery for cervical compressive myelopathy. METHODS The authors reviewed the cases of all consecutive patients with cervical compressive myelopathy who had undergone surgical treatment in the period between January 2012 and March 2017 at their institution. Using the Hospital Anxiety and Depression Scale (HADS), the authors classified patients as depressed (HADS-D+) or not depressed (HADS-D-) and anxious (HADS-A+) or not anxious (HADS-A-). Patient HRQOL was evaluated preoperatively and at the end of at least 1 year after surgery using the physical and mental component summaries of the SF-12 Health Survey, EQ-5D (EuroQol health survey of five dimensions), Neck Disability Index, and Japanese Orthopaedic Association scale. Patient satisfaction was evaluated on the basis of a seven-item questionnaire and divided into two categories: satisfied and dissatisfied. Preoperative HRQOL statuses, postoperative improvements in HRQOL outcomes, and patient satisfaction were compared between the groups. RESULTS Among the 121 patients eligible for inclusion in the study, there were 69 patients (57.0%) without depression (HADS-D-) and 52 (43.0%) with depression (HADS-D+) and 82 patients (67.8%) without anxiety (HADS-A-) and 39 (32.2%) with anxiety (HADS-A+). All patients who completed both the preoperative and postoperative questionnaires had significant postoperative improvements in all HRQOL outcomes. The HADS-D+ and HADS-A+ patients had poorer preoperative HRQOL statuses than the HADS-D- and HADS-A- patients, respectively. However, statistically significant improvements in all HRQOL outcomes were observed in both HADS-D+ and HADS-A+ patients. Patient satisfaction was comparable between the HADS-D or HADS-A groups. CONCLUSIONS Cervical compressive myelopathy patients with preoperative depression or anxiety according to the HADS tool had worse preoperative HRQOL statuses. However, patients with cervical compressive myelopathy showed significant improvements in HRQOL outcomes and had sufficient levels of satisfaction after surgery regardless of the presence of preoperative depression or anxiety.
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Affiliation(s)
- Toru Doi
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | | | - Koji Nakajima
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | - Shima Hirai
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | - Yusuke Sato
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | - So Kato
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | - Yuki Taniguchi
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | | | - Ko Matsudaira
- 2Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo; and
| | - Katsushi Takeshita
- 3Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Sakae Tanaka
- 1Department of Orthopaedic Surgery, The University of Tokyo
| | - Yasushi Oshima
- 1Department of Orthopaedic Surgery, The University of Tokyo
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