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Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease

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Abstract

Purpose

To identify the relationship between depression measured by Zung depression rating scale (ZDRS) and postoperative outcomes (including the patients reported outcomes [PRO] and clinical outcomes) two years after short-segment fusion surgery for degenerative lumbar spinal disease in older patients (aged 75 years and older).

Methods

We enrolled patients who underwent short-segment fusion surgery for lumbar degenerative disease from May 2018 to June 2020. All patients were assessed for depression using the ZDRS. Patients were included in the depression group and not-depressed group based on their scores. Preoperative baseline data were collected on characteristics, comorbidities, laboratory data, pain levels (visual analogue scale [VAS]), functional status (Oswestry Disability Index [ODI]), and surgery-related variables. The primary outcomes were PRO measures, including VAS, ODI and satisfaction two years after lumbar fusion surgery. Other outcomes included postoperative complications, the length of stay, and reoperation. Univariate and multivariate analyses were performed to identify the risk factors for poor satisfaction.

Results

A total of 231 patients (201 in not-depressed and 30 in depressed group) were enrolled in this study. There were no significant differences between the two groups for baseline data. Depressed group had higher rates of choices for dissatisfaction (36.7% vs. 14.0%, p = 0.015), higher VAS scores of low back pain (2.8 ± 2.3 vs. 1.6 ± 1.7, p = 0.012), and worse functional status (31.5 ± 22.5 vs 21.8 ± 19.9, p = 0.015) than the not-depressed group. Depressed patients reported significantly higher rates of postoperative complications and readmissions. Multivariate regression analysis revealed that depression (p = 0.001) was independently associated with postoperative dissatisfaction.

Conclusion

Preoperative depression was a risk factor for postoperative dissatisfaction, worse functional status, readmission, and complications in older patients undergoing lumbar fusion surgery. Preoperative screening using the Zung depression scale helps inform decision-making when considering fusion surgery for patients aged 75 and older.

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The underlying data supporting the results of this study could be obtained by contacting the corresponding author.

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Acknowledgements

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Funding

This research received grant from Beijing Municipal Medical Research Institute Public Welfare Development and Reform Pilot Project [grant number jingyiyan2019-2]. The sponsor had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 10053, China

    Shuai-Kang Wang, Peng Cui, Dong-Fan Wang, Peng Wang, Chao Kong & Shi-Bao Lu

  2. National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China

    Shuai-Kang Wang, Peng Cui, Dong-Fan Wang, Peng Wang, Chao Kong & Shi-Bao Lu

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  1. Shuai-Kang Wang
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Contributions

SKW and SBL contributed to the conception of the study. PC made an important contribution to the revision of the manuscript. DFW and PW contributed significantly to analysis and manuscript preparation. SKW and CK performed the data analyses and wrote the manuscript; CK and SBL helped perform the analysis with constructive discussions. SKW, PC, and DFW contribute equally to this work.

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Correspondence to Shi-Bao Lu.

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Written informed consent for publication of their clinical details and clinical images were obtained from the patient/parent/guardian/relative of the patient.

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This study was approved by the ethical review committee of Xuanwu Hospital, Capital Medical University. Informed consent was obtained from all subjects and/or their legal guardian(s). All methods were carried out in accordance with relevant guidelines and regulations.

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Wang, SK., Cui, P., Wang, DF. et al. Preoperative Zung depression scale predicts outcomes in older patients undergoing short-segment fusion surgery for degenerative lumbar spinal disease. Eur Spine J 32, 718–726 (2023). https://doi.org/10.1007/s00586-022-07497-0

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  • DOI: https://doi.org/10.1007/s00586-022-07497-0

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