Depression correlated with worse ODI scores after lumbar surgery: N2QOD study

Data for 120 patients in the National Neurosurgery Quality and Outcomes Lumbar Database treated by a single surgeon showed that preoperative depression and smoking impacted the clinical and quality of life outcomes of patients 3 months and 12 months after lumbar spine surgery.

Timothy C. Ryken, MD, MS, FACS, presented results for 120 patients of his whose data are entered in the lumbar spine module of the American Association of Neurological Surgeon’s National Neurosurgery Quality and Outcomes Lumbar Database (N2QOD), an initial project of the nationwide prospective longitudinal registry that uses patient reported outcome instruments. The goals of N2QOD lumbar spine surgery pilot study are to systematically measure and aggregate surgical safety and 1-year postoperative outcome data from multiple neurosurgical practices in the United States. Ryken participated in the program for a number of reasons.

“We all would like to know how our patients are doing and be able to report that to payers, other individuals and interested parties,” he said at a meeting.

About 50 sites now participate in the lumbar module and the number of sites participating in the cervical spine model is increasing, Ryken said.

Ryken and colleagues grouped the patients they looked at according to who was satisfied and who was not satisfied after lumbar surgery and looked further at both groups’ preoperative characteristics.

The number of smokers among Ryken’s patients exceed those in the overall N2QOD, he said. “There are twice as many dissatisfied patients in the smoker category as we would expect by a chi-squared analysis — so a significant issue that stays significant both when we look at ODI” and at the EuroQol-5D.

Patients who smoked had improved ODI scores by 3 months but did not maintain that improvement at later follow-up. The reason for that was unclear, according to Ryken.

There was a similar trend among depressed patients, although the overall impact of depression was neither significant nor easily characterized, Ryken said.

“If you look at the entire group, depressed patients do worse across the board. Their ODIs are lower, their EuroQol scores are lower. Therefore, they are going to become a factor in the cost analysis, as well,” Ryken said.

He noted that compared to the outcomes for patients who smoked, depressed patients’ outcomes showed they tended to improve. Their results also remained stable from the 3-month to the 12-month follow-up.

Ryken and colleagues also observed some trends with regards to costs of treatment that they analyzed separately. They wrote in the abstract, “No comorbidity we evaluated caused a significant change in the cost of surgery.”

“The depressed patients across the board: they cost more to take care of. They also reimbursed us more. But, if we move from a fee-for-service model to an overall cost model, the depressed population is going to be more expensive,” he said.

Ryken said the plans are to extend the study to include the 2-year data.

“What we really want to do with these data is, as we move to these different payment models, to make sure we are taking care of patients the most responsible and financially responsible way we can,” and avoid the situation where costly hardware has been placed in a patient who has a low likelihood of improving considerably,” he said. – by Susan M. Rapp

Reference:

Ryken TC. Paper #713. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

For more information:

Timothy C. Ryken, MD, MS, FAANS, can be reached at Iowa Spine & Brain Institute, 2710 St. Francis Dr., Waterloo, IA 50702.

Disclosure: Ryken is a consultant to Medtronic.