PMID- 27153146
OWN - NLM
STAT- MEDLINE
DCOM- 20170213
LR  - 20220331
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 25
IP  - 4
DP  - 2016 Oct
TI  - Impact of preoperative depression on 2-year clinical outcomes following adult 
      spinal deformity surgery: the importance of risk stratification based on type of 
      psychological distress.
PG  - 477-485
AB  - OBJECTIVE The objective of this study was to isolate whether the effect of a 
      baseline clinical history of depression on outcome is independent of associated 
      physical disability and to evaluate which mental health screening tool has the 
      most utility in determining 2-year clinical outcomes after adult spinal deformity 
      (ASD) surgery. METHODS Consecutively enrolled patients with ASD in a prospective, 
      multicenter ASD database who underwent surgical intervention with a minimum 
      2-year follow-up were retrospectively reviewed. A subset of patients who 
      completed the Distress and Risk Assessment Method (DRAM) was also analyzed. The 
      effects of categorical baseline depression and DRAM classification on the 
      Oswestry Disability Index (ODI), SF-36, and Scoliosis Research Society 
      questionnaire (SRS-22r) were assessed using univariate and multivariate linear 
      regression analyses. The probability of achieving >/= 1 minimal clinically 
      important difference (MCID) on the ODI based on the DRAM's Modified Somatic 
      Perceptions Questionnaire (MSPQ) score was estimated. RESULTS Of 267 patients, 66 
      (24.7%) had self-reported preoperative depression. Patients with baseline 
      depression had significantly more preoperative back pain, greater BMI and 
      Charlson Comorbidity Indices, higher ODIs, and lower SRS-22r and SF-36 
      Physical/Mental Component Summary (PCS/MCS) scores compared with those without 
      self-reported baseline depression. They also had more severe regional and global 
      sagittal malalignment. After adjusting for these differences, preoperative 
      depression did not impact 2-year ODI, PCS/MCS, or SRS-22r totals (p > 0.05). 
      Compared with those in the "normal" DRAM category, "distressed somatics" (n = 11) 
      had higher ODI (+23.5 points), lower PCS (-10.9), SRS-22r activity (-0.9), and 
      SRS-22r total (-0.8) scores (p </= 0.01), while "distressed depressives" (n = 25) 
      had lower PCS (-8.4) and SRS-22r total (-0.5) scores (p < 0.05). After adjusting 
      for important covariates, each additional point on the baseline MSPQ was 
      associated with a 0.8-point increase in 2-year ODI (p = 0.03). The probability of 
      improving by at least 1 MCID in 2-year ODI ranged from 77% to 21% for MSPQ scores 
      0-20, respectively. CONCLUSIONS A baseline clinical history of depression does 
      not correlate with worse 2-year outcomes after ASD surgery after adjusting for 
      baseline differences in comorbidities, health-related quality of life, and spinal 
      deformity severity. Conversely, DRAM improved risk stratification of patient 
      subgroups predisposed to achieving suboptimal surgical outcomes. The DRAM's MSPQ 
      was more predictive than MCS and SRS mental domain for 2-year outcomes and may be 
      a valuable tool for surgical screening.
FAU - Theologis, Alexander A
AU  - Theologis AA
AD  - Departments of Orthopaedic Surgery and.
FAU - Ailon, Tamir
AU  - Ailon T
AD  - Department of Neurosurgery, University of Virginia Medical Center, 
      Charlottesville, Virginia.
FAU - Scheer, Justin K
AU  - Scheer JK
AD  - School of Medicine, University of California, San Diego School of Medicine, San 
      Diego, California.
FAU - Smith, Justin S
AU  - Smith JS
AD  - Department of Neurosurgery, University of Virginia Medical Center, 
      Charlottesville, Virginia.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - Department of Neurosurgery, University of Virginia Medical Center, 
      Charlottesville, Virginia.
FAU - Bess, Shay
AU  - Bess S
AD  - Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, 
      Colorado.
FAU - Gupta, Munish
AU  - Gupta M
AD  - Department of Orthopedic Surgery, California, Davis, Sacramento, California.
FAU - Klineberg, Eric O
AU  - Klineberg EO
AD  - Department of Orthopedic Surgery, California, Davis, Sacramento, California.
FAU - Kebaish, Khaled
AU  - Kebaish K
AD  - Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland.
FAU - Schwab, Frank
AU  - Schwab F
AD  - Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New 
      York.
FAU - Lafage, Virginie
AU  - Lafage V
AD  - Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New 
      York.
FAU - Burton, Douglas
AU  - Burton D
AD  - Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas 
      City, Kansas; and.
FAU - Hart, Robert
AU  - Hart R
AD  - Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, 
      Oregon.
FAU - Ames, Christopher P
AU  - Ames CP
AD  - Neurosurgery, University of California, San Francisco, California.
CN  - International Spine Study Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20160506
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Comorbidity
MH  - Databases, Factual
MH  - Depression/*complications/epidemiology
MH  - Disability Evaluation
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Prospective Studies
MH  - Psychiatric Status Rating Scales
MH  - Quality of Life
MH  - Retrospective Studies
MH  - Risk
MH  - Self Report
MH  - Severity of Illness Index
MH  - Spinal Curvatures/complications/*psychology/*surgery
MH  - Stress, Psychological/*complications/epidemiology
MH  - Treatment Outcome
OTO - NOTNLM
OT  - ASA = American Society of Anesthesiologists
OT  - ASD = adult spinal deformity
OT  - BMI = body mass index
OT  - CCI = Charlson Comorbidity Index
OT  - DRAM = Distress and Risk Assessment Method
OT  - Distress and Risk Assessment Method
OT  - EBL = estimated blood loss
OT  - HRQOL = health-related quality of life
OT  - LOS = length of stay
OT  - MCID = minimal clinically important difference
OT  - MCS = Mental Component Summary of the SF-36
OT  - MSPQ = Modified Somatic Perceptions Questionnaire
OT  - ODI = Oswestry Disability Index
OT  - PCS = Physical Component Summary of the SF-36
OT  - PI-LL = pelvic incidence-lumbar lordosis
OT  - PT = pelvic tilt
OT  - SRS-22r = Scoliosis Research Society
OT  - SVA = sagittal vertical axis
OT  - TK = thoracic kyphosis
OT  - ZDS = Zung Self-Rating Depression Scale
OT  - adult spinal deformity
OT  - depression
OT  - health-related quality of life
OT  - mZDI = Modified Zung Depression Index
OT  - psychological distress
OT  - risk stratification
EDAT- 2016/05/07 06:00
MHDA- 2017/02/14 06:00
CRDT- 2016/05/07 06:00
PHST- 2016/05/07 06:00 [pubmed]
PHST- 2017/02/14 06:00 [medline]
PHST- 2016/05/07 06:00 [entrez]
AID - 10.3171/2016.2.SPINE15980 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2016 Oct;25(4):477-485. doi: 10.3171/2016.2.SPINE15980. Epub 
      2016 May 6.