Psychosocial factors and surgical outcomes: Are elderly depressed patients less satisfied with surgery?

Owoicho Adogwa, Kevin Carr, Parastou Fatemi, Terence Verla, Gustavo Gazcon, Oren Gottfried, Carlos Bagley, Joseph Cheng

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Study Design. Longitudinal cohort study. Objective. In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery. Summary of Background Data. Patient satisfaction ratings are increasingly being used in health care as a proxy for quality of care. In the elderly, affective disorders such as depression have been shown to influence patient-reported outcomes and self-interpretation of health status. Methods. A total of 69 patients aged 65 years or older undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score, comorbidities, and postoperative satisfaction with surgical care and outcome were assessed for all patients. Baseline and 2-year visual analogue scale (VAS)-leg pain, VAS-back pain, Oswestry Disability Index, Short Form-12 physical component score and Short Form-12 mental com onent score, as well as health-state utility (EuroQol 5D) were assessed. Factors associated with patient satisfaction after surgical procedures were assessed via multivariate logistic regression analysis. Results. Compared with baseline, there was a statistically significant improvement in VAS-back pain 2.76 ± 2.73 (pseudarthrosis [1.94 ± 2.81], adjacent segment disease [4.35 ± 3.16]), same-level recurrent stenosis [2 ± 2.23]), VAS-leg pain 2.66 ± 4.12, (adjacent segment disease [2.24 ± 4.46] and same-level recurrent stenosis [3 ± 3.78]). Two-year Oswestry Disability Index improved after surgery for pseudarthrosis (4.05 ± 7.65), adjacent segment disease (6 ± 13.63) and same-level recurrent stenosis (4.54 ± 5.97). In a multivariate logistical regression model, increasing preoperative Zung self-rating depression scale scores were independently associated with patient dissatisfaction 2 years after revision lumbar surgery, (P < 0.001). Conclusion. This study demonstrates that independent of surgical effectiveness, baseline depression influence patient satisfaction with health care, 2 years after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality of care should account for patients' baseline depression as a potential confounder especially in this age group.

Original languageEnglish (US)
Pages (from-to)1614-1619
Number of pages6
JournalSpine
Volume39
Issue number19
DOIs
StatePublished - Sep 1 2014

Fingerprint

Patient Satisfaction
Depression
Psychology
Pathologic Constriction
Back Pain
Reoperation
Leg
Pseudarthrosis
Quality of Health Care
Proxy
Pain Measurement
Visual Analog Scale
Delivery of Health Care
Quality Improvement
Decompression
Mood Disorders
Health Status
Longitudinal Studies
Comorbidity
Cohort Studies

Keywords

  • depression
  • elderly
  • health care quality
  • Oswestry Disability Index
  • patient dissatisfaction
  • patient satisfaction
  • spine surgery
  • visual analogue score
  • Zung self-rating depression score

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Adogwa, O., Carr, K., Fatemi, P., Verla, T., Gazcon, G., Gottfried, O., ... Cheng, J. (2014). Psychosocial factors and surgical outcomes: Are elderly depressed patients less satisfied with surgery? Spine, 39(19), 1614-1619. https://doi.org/10.1097/BRS.0000000000000474

Psychosocial factors and surgical outcomes : Are elderly depressed patients less satisfied with surgery? / Adogwa, Owoicho; Carr, Kevin; Fatemi, Parastou; Verla, Terence; Gazcon, Gustavo; Gottfried, Oren; Bagley, Carlos; Cheng, Joseph.

In: Spine, Vol. 39, No. 19, 01.09.2014, p. 1614-1619.

Research output: Contribution to journalArticle

Adogwa, O, Carr, K, Fatemi, P, Verla, T, Gazcon, G, Gottfried, O, Bagley, C & Cheng, J 2014, 'Psychosocial factors and surgical outcomes: Are elderly depressed patients less satisfied with surgery?', Spine, vol. 39, no. 19, pp. 1614-1619. https://doi.org/10.1097/BRS.0000000000000474
Adogwa, Owoicho ; Carr, Kevin ; Fatemi, Parastou ; Verla, Terence ; Gazcon, Gustavo ; Gottfried, Oren ; Bagley, Carlos ; Cheng, Joseph. / Psychosocial factors and surgical outcomes : Are elderly depressed patients less satisfied with surgery?. In: Spine. 2014 ; Vol. 39, No. 19. pp. 1614-1619.
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abstract = "Study Design. Longitudinal cohort study. Objective. In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery. Summary of Background Data. Patient satisfaction ratings are increasingly being used in health care as a proxy for quality of care. In the elderly, affective disorders such as depression have been shown to influence patient-reported outcomes and self-interpretation of health status. Methods. A total of 69 patients aged 65 years or older undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score, comorbidities, and postoperative satisfaction with surgical care and outcome were assessed for all patients. Baseline and 2-year visual analogue scale (VAS)-leg pain, VAS-back pain, Oswestry Disability Index, Short Form-12 physical component score and Short Form-12 mental com onent score, as well as health-state utility (EuroQol 5D) were assessed. Factors associated with patient satisfaction after surgical procedures were assessed via multivariate logistic regression analysis. Results. Compared with baseline, there was a statistically significant improvement in VAS-back pain 2.76 ± 2.73 (pseudarthrosis [1.94 ± 2.81], adjacent segment disease [4.35 ± 3.16]), same-level recurrent stenosis [2 ± 2.23]), VAS-leg pain 2.66 ± 4.12, (adjacent segment disease [2.24 ± 4.46] and same-level recurrent stenosis [3 ± 3.78]). Two-year Oswestry Disability Index improved after surgery for pseudarthrosis (4.05 ± 7.65), adjacent segment disease (6 ± 13.63) and same-level recurrent stenosis (4.54 ± 5.97). In a multivariate logistical regression model, increasing preoperative Zung self-rating depression scale scores were independently associated with patient dissatisfaction 2 years after revision lumbar surgery, (P < 0.001). Conclusion. This study demonstrates that independent of surgical effectiveness, baseline depression influence patient satisfaction with health care, 2 years after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality of care should account for patients' baseline depression as a potential confounder especially in this age group.",
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AU - Gottfried, Oren

AU - Bagley, Carlos

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N2 - Study Design. Longitudinal cohort study. Objective. In this study, we set out to assess the effect of preoperative depression on patient satisfaction after revision lumbar surgery. Summary of Background Data. Patient satisfaction ratings are increasingly being used in health care as a proxy for quality of care. In the elderly, affective disorders such as depression have been shown to influence patient-reported outcomes and self-interpretation of health status. Methods. A total of 69 patients aged 65 years or older undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score, comorbidities, and postoperative satisfaction with surgical care and outcome were assessed for all patients. Baseline and 2-year visual analogue scale (VAS)-leg pain, VAS-back pain, Oswestry Disability Index, Short Form-12 physical component score and Short Form-12 mental com onent score, as well as health-state utility (EuroQol 5D) were assessed. Factors associated with patient satisfaction after surgical procedures were assessed via multivariate logistic regression analysis. Results. Compared with baseline, there was a statistically significant improvement in VAS-back pain 2.76 ± 2.73 (pseudarthrosis [1.94 ± 2.81], adjacent segment disease [4.35 ± 3.16]), same-level recurrent stenosis [2 ± 2.23]), VAS-leg pain 2.66 ± 4.12, (adjacent segment disease [2.24 ± 4.46] and same-level recurrent stenosis [3 ± 3.78]). Two-year Oswestry Disability Index improved after surgery for pseudarthrosis (4.05 ± 7.65), adjacent segment disease (6 ± 13.63) and same-level recurrent stenosis (4.54 ± 5.97). In a multivariate logistical regression model, increasing preoperative Zung self-rating depression scale scores were independently associated with patient dissatisfaction 2 years after revision lumbar surgery, (P < 0.001). Conclusion. This study demonstrates that independent of surgical effectiveness, baseline depression influence patient satisfaction with health care, 2 years after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality of care should account for patients' baseline depression as a potential confounder especially in this age group.

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KW - patient dissatisfaction

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KW - spine surgery

KW - visual analogue score

KW - Zung self-rating depression score

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