Influence of Psychiatric Comorbidities on Clinical Outcome Before and after Elective Spine Surgery. A Prospective Observational Study

Introduction It is widely accepted that psychiatric comorbidities have a negative influence on health-related quality of life and long-term outcomes following spine surgery. However, most published data are restricted to postoperative measurements and data from preoperative settings in lacking. Aim of this study was to assess the incidence and influence of psychiatric comorbidities on clinical outcome in patients undergoing elective spine surgery. Methods A prospective study of patients undergoing elective spine surgery was performed. Evaluation for depression (ADS-K score) and anxiety (STAI-S, STAI-T and ASI-3 scores) before surgery and at three months follow up were done. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and 3 months postoperatively. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined. Results 144 patients met all inclusion criteria. 78 patients were male (54,2%); mean age was 59.49 years. Most patients were married or in a steady relationship (77,8%). Abnormal STAI-S, STAI-T and ASI-3 anxiety scores were encountered preoperatively in 51,4%, 39,6% and 11.8% of cases but resolved in 38,6%, 31,9% and 11,1% of cases at 3 months follow up. 17,36%, 11,11%, 5,55% reported abnormal STAI-S, STAI-T and ASI-3 anxiety scores only following surgery, respectively. Abnormal ADK-S score were seen in 25% of cases before surgery and resolved in 14,6% of cases at 3 months follow-up. 5.55% of patients showed abnormal ASD-K scores only following surgery. Patients with an anxiety disorders at follow up had a worse clinical outcome compared with there counterparts (ODI: 43.07 vs 35.67, p = 0,304; VAS pain: 43.07 vs 5.54, p = 0.000, PCS: 42.08 vs 41.83, p = 0.949). Pathologic depression scores also had a negative influence on most clinical outcome measurements (ODI: 10.44.3 vs 26.4, p = 0.000; VAS pain: 10.49 vs 3.97, p = 0.000, PCS: 10.03 versus 48.93, p = 0,000). Conclusions The incidence of depression and anxiety disorders in patients undergoing elective spine surgery is very high. This was also associated with unfavorable outcome. Most cases of depression and anxiety were present prior to surgery. More patients are needed to asses the possibly of preoperative screening for such comorbidities as many of the patients psychiatric problems resolved after surgery.