合并抑郁和焦虑是否预示着腰椎滑脱症手术后的长期疗效不佳?质量结果数据库的五年分析。

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Journal of neurosurgery. Spine Pub Date : 2024-09-06 Print Date: 2024-11-01 DOI:10.3171/2024.5.SPINE24325
Joseph DiDomenico, S Harrison Farber, Michael S Virk, Jakub Godzik, Sarah E Johnson, Mohamad Bydon, Praveen V Mummaneni, Erica F Bisson, Steven D Glassman, Andrew K Chan, Dean Chou, Kai-Ming Fu, Christopher I Shaffrey, Anthony L Asher, Domagoj Coric, Eric A Potts, Kevin T Foley, Michael Y Wang, John J Knightly, Paul Park, Mark E Shaffrey, Jonathan R Slotkin, Regis W Haid, Juan S Uribe, Jay D Turner
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引用次数: 0

摘要

目的:抑郁和焦虑与脊柱手术后的不良预后有关。然而,这些情况对腰椎手术后达到最小临床重要差异(MCID)的影响,以及合并抑郁和焦虑症可能产生的复合效应还不甚了解。本研究探讨了合并抑郁和焦虑症对退行性腰椎滑脱症手术治疗后长期临床疗效的影响:本研究对多中心、前瞻性收集的质量结果数据库(QOD)进行了回顾性分析。研究纳入了来自 12 个中心、接受过手术治疗的 1 级腰椎滑脱症患者。记录了术前基线特征和合并症,包括自我报告的抑郁和/或焦虑。记录了术前和术后患者报告结果(PROs):腰痛数字评分量表(NRS)评分(NRS-BP)、腿痛数字评分量表(NRS-LP)评分、Oswestry残疾指数(ODI)和EQ-5D。患者被分为三组:无自述抑郁或焦虑(非 SRD/A)、自述抑郁或焦虑(SRD/A)或同时存在两种合并症(SRD+A)。比较了PROs随时间的变化、满意率和MCID率。进行了多变量回归分析,以建立独立的关联:在 608 名患者中,452 人(74.3%)患有非 SRD/A,81 人(13.3%)患有 SRD/A,75 人(12.3%)患有 SRD+A。总体而言,分别有 91.8% 和 80.4% 的患者接受了≥ 24 个月和≥ 60 个月的随访。SRD+A队列的基线PRO普遍较差。然而,在随访60个月时,SRD+A组群的所有PROs变化最大,导致3个组群的NRS-BP、NRS-LP、ODI和EQ-5D绝对值差异不显著。SRD+A 组的 MCID 达到率与非 SRD/A 组相似。所有组别的手术满意度均大于 80%,各组别之间无显著差异(p = 0.79)。在多变量回归中,合并抑郁和焦虑与较差的基线PROs有关,但它们对60个月的PROs或60个月的MCIDs达标率没有影响:结论:尽管基线PRO较低,但合并抑郁和焦虑症的患者在腰椎滑脱症手术后的MCID和满意度与无这两种情况的患者相当。这种生活质量方面的益处在5年的随访中依然存在。这些数据表明,不应将自述合并抑郁和焦虑的患者排除在手术干预的考虑范围之外,他们往往能从手术中获益良多。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does comorbid depression and anxiety portend poor long-term outcomes following surgery for lumbar spondylolisthesis? Five-year analysis of the Quality Outcomes Database.

Objective: Depression and anxiety are associated with poor outcomes following spine surgery. However, the influence of these conditions on achieving a minimal clinically important difference (MCID) following lumbar spine surgery, as well as the potential compounding effects of comorbid depression and anxiety, is not well understood. This study explores the impact of comorbid depression and anxiety on long-term clinical outcomes following surgical treatment for degenerative lumbar spondylolisthesis.

Methods: This study was a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade 1 lumbar spondylolisthesis from 12 centers were included. Preoperative baseline characteristics and comorbidities were recorded, including self-reported depression and/or anxiety. Pre- and postoperative patient-reported outcomes (PROs) were recorded: the numeric rating scale (NRS) score for back pain (NRS-BP), NRS score for leg pain (NRS-LP), Oswestry Disability Index (ODI), and EQ-5D. Patients were grouped into 3 cohorts: no self-reported depression or anxiety (non-SRD/A), self-reported depression or anxiety (SRD/A), or presence of both comorbidities (SRD+A). Changes in PROs over time, satisfaction rates, and rates of MCID were compared. A multivariable regression analysis was performed to establish independent associations.

Results: Of the 608 patients, there were 452 (74.3%) with non-SRD/A, 81 (13.3%) with SRD/A, and 75 (12.3%) with SRD+A. Overall, 91.8% and 80.4% of patients had ≥ 24 and ≥ 60 months of follow-up, respectively. Baseline PROs were universally inferior for the SRD+A cohort. However, at 60-month follow-up, changes in all PROs were greatest for the SRD+A cohort, resulting in nonsignificant differences in absolute NRS-BP, NRS-LP, ODI, and EQ-5D across the 3 groups. MCID was achieved for the SRD+A cohort at similar rates to the non-SRD/A cohort. All groups achieved > 80% satisfaction rates with surgery without significant differences across the cohorts (p = 0.79). On multivariable regression, comorbid depression and anxiety were associated with worse baseline PROs, but they had no impact on 60-month PROs or 60-month achievement of MCIDs.

Conclusions: Despite lower baseline PROs, patients with comorbid depression and anxiety achieved comparable rates of MCID and satisfaction after surgery for lumbar spondylolisthesis to those without either condition. This quality-of-life benefit was durable at 5-year follow-up. These data suggest that patients with self-reported comorbid depression and anxiety should not be excluded from consideration of surgical intervention and often substantially benefit from surgery.

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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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