Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers' compensation subjects

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 40; no. 10; p. 748
• Main Authors: Anderson, Joshua T, Haas, Arnold R, Percy, Rick, Woods, Stephen T, Ahn, Uri M, Ahn, Nicholas U
• Format: Journal Article
• Language: English
• Published: United States 15.05.2015
• Subjects: Absenteeism; Adult; Chi-Square Distribution; Chronic Pain - diagnosis; Chronic Pain - epidemiology; Chronic Pain - psychology; Chronic Pain - surgery; Comorbidity; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Female; Humans; Logistic Models; Low Back Pain - diagnosis; Low Back Pain - epidemiology; Low Back Pain - psychology; Low Back Pain - surgery; Lumbar Vertebrae - surgery; Male; Middle Aged; Multivariate Analysis; Occupational Health; Odds Ratio; Ohio - epidemiology; Retrospective Studies; Return to Work; Risk Factors; Sick Leave; Spinal Fusion - adverse effects; Spinal Fusion - psychology; Time Factors; Treatment Outcome; Workers' Compensation; Ohio
• ISSN: 1528-1159
• DOI: 10.1097/BRS.0000000000000863

Retrospective cohort study. Determine how psychosocial factors, particularly depression, impact lumbar fusion outcomes in a workers' compensation (WC) setting. WC patients are less likely to return to work (RTW) after fusion. Few studies evaluate risk factors within this clinically distinct population. A total of 2799 Ohio WC subjects were identified who underwent lumbar fusion between 1993 and 2013 using Current Procedural Terminology (CPT) procedural and International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. A total of 123 subjects were diagnosed with depression before fusion. Subjects with a smoking history, prior lumbar surgery, permanent disability, and failed back syndrome were excluded. The primary outcome was whether subjects returned to work within 2 years of fusion and sustained this RTW for more than 6 months of the following year. To determine the impact depression had on RTW status, we performed a multivariate logistic regression analysis. We also compared time absent from work and other secondary outcomes using χ2 and t tests. Subjects with preoperative depression had significantly higher rates of legal representation, degenerative lumbar disease, and higher medical costs, and used opioid analgesics for considerably longer before and after fusion (P<0.001).Depression group (10.6% [13/123]) and controls (33.0% [884/2676]) met our RTW criteria (P<0.001). Preoperative depression was a negative predictor of RTW status (P<0.001; odds ratio [OR]: 0.38). Additional predictors included working during same week as fusion (OR: 2.15), age more than 50 years (OR: 0.58), chronic preoperative opioid analgesia (OR: 0.58), and legal representation (OR: 0.64). After surgery, depression subjects were absent from work 184 more days compared with controls (P<0.001). Overall, RTW rates after fusion were low, which was especially true for those with pre-existing depression. Depression was a strong negative predictor of postoperative RTW status. Psychological screening and treatment may be beneficial in these subjects. The poor outcomes in this study may highlight a more limited role for fusion among WC subjects with chronic low back pain where RTW is the treatment goal. 3.