The Differing Effects of Ethnicity on Mental Health Outcomes Among Patients Undergoing Lumbar Fusion Surgery

Abstract

Few studies have explored the effect of ethnicity on postoperative mental health outcomes. This study aims to evaluate the effect of ethnicity on changes in mental health outcomes following lumbar fusion (LF). A surgical database was retrospectively reviewed for primary, single, or multilevel, lumbar fusion with posterior instrumentation procedures. Patients were propensity score matched to account for differences in demographics. 12-Item Short Form and Veterans RAND (SF-12 and VR-12) Mental Composite Score (MCS), 9-Item Patient Health Questionnaire (PHQ-9), Visual Analogue Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were recorded. A minimum clinically important difference (MCID) was calculated. Patients were grouped according to ethnicity: African-American, Hispanic, Asian/Other, and Caucasian. Differences between groups in baseline characteristics and mean outcome scores were evaluated. Ethnicity was assessed as a predictor of mental health outcomes and achievement of MCID was evaluated using regression analysis. The study included 224 patients, 43 African-American, 40 Hispanic, 22 Asian/Other, and 119 Caucasian. Groups differed in age, comorbidity score, and insurance collected (p<0.05). African-Americans had the longest postoperative stay (47.3 hours; p=0.032). Groups differed in preoperative SF-12 and VR-12 MCS, but not PHQ-9 (p<0.001, both). Groups demonstrated differences in postoperative SF-12 MCS (p≤0.021), VR-12 MCS (p≤0.028), PHQ-9 (p=0.009). VAS back, VAS leg, and ODI demonstrated significantly different scores (p≤0.041, all). Ethnicity was not a predictor of mental health outcomes at any timepoint and did not demonstrate an impact on achievement of MCID. Majority of individuals achieved an MCID by 1-year for all outcomes. Preoperative mental health scores demonstrated significant differences based on a patient’s ethnicity but was resolved by 2-years. Ethnicity did not demonstrate significant effects on the ability to achieve an MCID for mental health outcomes. These results suggest that patients of differing backgrounds may require alternative preoperative counseling.