Positive Preprocedure Depression Screening Is Associated With Worse Outcomes After Single-Level Posterior-Only Lumbar Fusion: A Retrospective Cohort Analysis

BACKGROUND AND OBJECTIVES: Major depressive disorder affects approximately 10% of all adults in the United States, but the condition remains underdiagnosed for patients with degenerative spine disease and radicular pain. The impact of comorbid undiagnosed depression on postoperative outcomes after lumbar fusion is not well characterized and may contribute to excessive health care utilization. This study isolates the relationship between undiagnosed depression, assessed by the Patient Health Questionnaire 2 (PHQ-2) screening tool, and short-term postoperative outcomes after single-level posterior lumbar fusion. METHODS: PHQ-2 data were prospectively collected, and retrospectively reviewed, among consecutive patients (n = 3225) undergoing single-level posterior-only lumbar spinal fusion surgery over 10 years at a multihospital academic medical center. Coarsened exact matching analysis was performed to match patients on factors known to affect outcome, isolating the impact of PHQ-2 scores. Matched characteristics included sex, race, body mass index, smoking status, median household income, and medical comorbidities determined by the Charlson Comorbidity Index. Primary outcomes were emergency department visits, readmission, and discharge disposition after surgery. Secondary outcomes included reoperation, intraoperative complications, and length of postoperative stay. RESULTS: Amongst all patients undergoing surgery, 306 (9.5%) patients showed risk for depression (PHQ-2 scores of 3-6). High-risk patients had significantly more 90-day postoperative emergency department visits ( P = .0348, odds ratio = 1.93 [1.04, 3.61]) when compared with otherwise matched patients with no risk factors for depression (PHQ-2 score 0). There were no differences in intraoperative complications, length of stay, discharge disposition, readmissions, or reoperations. CONCLUSION: Elevated preoperative PHQ-2 depression screening scores are associated with increased postoperative resource utilization after lumbar spinal fusion. The PHQ-2, as a predictor of undiagnosed depression, may identify high-risk populations before surgery. Prospective studies to assess mitigation strategies to improve outcomes, and reduce resource utilization, are warranted.