Clinical Depression Is a Strong Predictor of Poor Lumbar Fusion Outcomes Among Workers' Compensation Subjects. Issue 10 (15th May 2015)

• Record Type: Journal Article
• Authors: Anderson, Joshua T.; Haas, Arnold R.; Percy, Rick; Woods, Stephen T.; Ahn, Uri M.; Ahn, Nicholas U.
• Is Part Of: Spine. Volume 40:Issue 10(2015)
• Publication Date: 2015-05-15
• Subjects: Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000863
• Languages: English
• ISSNs: 0362-2436

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Study Design.</title> <p>Retrospective cohort study.</p> </sec> <sec> <title>Objective.</title> <p>Determine how psychosocial factors, particularly depression, impact lumbar fusion outcomes in a workers' compensation (WC) setting.</p> </sec> <sec> <title>Summary of Background Data.</title> <p>WC patients are less likely to return to work (RTW) after fusion. Few studies evaluate risk factors within this clinically distinct population.</p> </sec> <sec> <title>Methods.</title> <p>A total of 2799 Ohio WC subjects were identified who underwent lumbar fusion between 1993 and 2013 using <italic>Current Procedural Terminology</italic> (<italic>CPT</italic>) procedural and <italic>International Classification of Diseases, Ninth Revision</italic> (<italic>ICD-9</italic>) diagnosis codes. A total of 123 subjects were diagnosed with depression before fusion. Subjects with a smoking history, prior lumbar surgery, permanent disability, and failed back syndrome were excluded. The primary outcome was whether subjects returned to work within 2 years of fusion and sustained this RTW for more than 6 months of the following year. To determine the impact depression had on RTW status, we performed a multivariate logistic regression analysis. We also compared time absent from work and other secondary outcomes using χ<sup>2</sup> and <italic>t</italic> tests.</p> </sec> <sec> <title>Results.</title> <p>Subjects with preoperative depression had significantly higher rates of legal representation, degenerative lumbar disease, and higher medical costs, and used opioid analgesics for considerably longer before and after fusion (<italic>P</italic> < 0.001).</p> <p>Depression group (10.6% [13/123]) and controls (33.0% [884/2676]) met our RTW criteria (<italic>P</italic> < 0.001). Preoperative depression was a negative predictor of RTW status (<italic>P</italic> < 0.001; odds ratio [OR]: 0.38). Additional predictors included working during same week as fusion (OR: 2.15), age more than 50 years (OR: 0.58), chronic preoperative opioid analgesia (OR: 0.58), and legal representation (OR: 0.64). After surgery, depression subjects were absent from work 184 more days compared with controls (<italic>P</italic> < 0.001).</p> </sec> <sec> <title>Conclusion.</title> <p>Overall, RTW rates after fusion were low, which was especially true for those with pre-existing depression. Depression was a strong negative predictor of postoperative RTW status. Psychological screening and treatment may be beneficial in these subjects. The poor outcomes in this study may highlight a more limited role for fusion among WC subjects with chronic low back pain where RTW is the treatment goal.</p> <p> <bold>Level of Evidence:</bold> 3</p> </sec> </abstract>