PT - JOURNAL ARTICLE AU - Dhruv K.C. Goyal AU - Justin D. Stull AU - Srikanth N. Divi AU - Matthew S. Galetta AU - Daniel R. Bowles AU - Kristen J. Nicholson AU - I. David Kaye AU - Barrett I. Woods AU - Mark F. Kurd AU - Kris E. Radcliff AU - Jeffrey A. Rihn AU - D. Greg Anderson AU - Alan S. Hilibrand AU - Christopher K. Kepler AU - Alexander R. Vaccaro AU - Gregory D. Schroeder TI - Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion AID - 10.14444/8008 DP - 2021 Apr 01 TA - International Journal of Spine Surgery PG - 234--242 VI - 15 IP - 2 4099 - http://ijssurgery.com//content/15/2/234.short 4100 - http://ijssurgery.com//content/15/2/234.full SO - Int J Spine Surg2021 Apr 01; 15 AB - Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis.Methods: Patients undergoing 1- to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart. Patients were separated into 3 groups: no depression or anxiety (NDA), depression or anxiety alone (DOA), and combined depression and anxiety (DAA). Absolute PROMs, recovery ratios, and the percentage of patients achieving minimal clinically important difference (% MCID) between groups were compared using univariate and multivariate analysis.Results: Of the 391 patients included in the cohort, 323 (82.6%) were in the NDA group, 37 (9.5%) in the DOA group, and 31 (7.9%) in the DAA group. Patients in the DAA group had significantly worse outcome scores before and after surgery with respect to Short Form-12 mental component score (MCS-12) and Oswestry Disability Index (ODI) scores (P <.001); however, the change in PROMs, recovery ratio, % MCID were not found to be significantly different between groups. Using multivariate analysis, the DAA group was found to be an independent predictor of worse improvement in MCS-12 and ODI scores (P = .026 and P = .001, respectively).Conclusions: Patients with combined anxiety and depression fared worse with respect to disability before and after surgery compared to patients with a single diagnosis or no mental health diagnosis; however, there were no significant differences in recovery ratio or % MCID.Level of Evidence: 3.Clinical Relevance: Combined anxiety and depression may predict less improvement in MCS-12 and ODI after lumbar arthrodesis compared with single or no mental health diagnosis.