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

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.