Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients.
Mental Health Associated With Postoperative Satisfaction in Lumbar Degenerative Surgery Patients.
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DOI：
10.1097/bsd.0000000000001106
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发表时间：
2021-12-01
影响因子：
1.9
通讯作者：
Neuman BJ
中科院分区：
文献类型：
--
作者：
Rahman R;Zhang B;Andrade NS;Ibaseta A;Kebaish KM;Riley LH 3rd;Cohen DB;Jain A;Lee SH;Sciubba DM;Skolasky RL;Neuman BJ
前瞻性收集数据的回顾性审查旨在评估腰椎退行性手术患者术前和术后心理健康状况与术后满意度之间的相关性。术前心理健康不良已被证明对脊柱手术患者的术后满意度产生负面影响，但术后心理健康对满意度影响的证据有限。纳入了在一家机构接受腰椎退行性疾病手术的成人患者。术前和术后12个月使用PROMIS抑郁和焦虑评分评估心理健康。术后12个月使用NASS患者满意度指数（PSI）评估满意度。我们用单变量和多变量逻辑回归评估心理健康和满意度之间的关系，以调整混杂因素。根据术后抑郁/焦虑水平校正术前抑郁/焦虑水平，反之亦然。在α=0.05时评估统计学显著性。183例患者（47%男性;平均年龄62岁）。术前27%和术后29%存在抑郁，术前50%和术后31%存在焦虑。19%报告了使用NASS PSI的术后不满意。单变量分析确定种族、家庭收入、关系状况、当前吸烟状况、疼痛干扰的变化和身体功能的变化为潜在混杂因素。在校正分析中，轻度术后抑郁（校正比值比[aOR] = 6.1; 95%置信区间[CI] = 1.2，32; p=0.03）和中度或重度术后抑郁（aOR = 7.5; 95% CI = 1.3，52; p=0.03）患者的不满意度比值增加。术前、术后焦虑和术前抑郁与术后满意度无关。腰椎退行性手术后，无论术前抑郁状态如何，术后抑郁患者的不满意率明显较高。这些结果强调了对脊柱不满意患者进行术后抑郁筛查和治疗的重要性。
Retrospective review of prospectively collected data To assess the association between preoperative and postoperative mental health status with postoperative satisfaction in lumbar degenerative surgery patients. Poor preoperative mental health has been shown to negatively affect postoperative satisfaction among spine surgery patients, but there is limited evidence on the impact of postoperative mental health on satisfaction. Adult patients undergoing surgery for lumbar degenerative conditions at a single institution were included. Mental health was assessed preoperatively and 12-months postoperatively using PROMIS Depression and Anxiety scores. Satisfaction was assessed 12-months postoperatively using NASS Patient Satisfaction Index (PSI). We evaluated associations between mental health and satisfaction with univariate and multivariable logistic regression to adjust for confounders. Preoperative depression/anxiety level was corrected for postoperative depression/anxiety level, and vice versa. Statistical significance was assessed at α=0.05. 183 patients (47% male; avg. age 62 years) were included. Depression was present in 27% preoperatively and 29% postoperatively, and anxiety in 50% preoperatively and 31% postoperatively. 19% reported postoperative dissatisfaction using NASS PSI. Univariate analysis identified race, family income, relationship status, current smoking status, change in pain interference, and change in physical function as potential confounders. In adjusted analysis, odds of dissatisfaction were increased in those with mild postoperative depression (adjusted odds ratio [aOR] = 6.1; 95% confidence interval [CI] = 1.2, 32; p=0.03) and moderate or severe postoperative depression (aOR = 7.5; 95% CI = 1.3, 52; p=0.03). Preoperative and postoperative anxiety and preoperative depression were not associated with postoperative satisfaction. Following lumbar degenerative surgery, patients with postoperative depression, irrespective of preoperative depression status, have significantly higher odds of dissatisfaction. These results emphasize the importance of postoperative screening and treatment of depression in spine patients with dissatisfaction.