64. Impact of depression on patient reported outcomes following primary vs revision ACDF

Abstract

BACKGROUND CONTEXT Depression has been associated with poorer outcomes following anterior cervical discectomy and fusion (ACDF). However, research examining the relationship between depression and patient reported outcome measures (PROMs) in revision ACDF procedures is limited. PURPOSE To assess the relationship of depressive symptoms with PROMs in patients undergoing either primary or revision ACDF procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE 143 patients undergoing primary or revision, single- or multilevel ACDF procedures. OUTCOME MEASURES Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS), Neck Disability Index (NDI). METHODS A prospective database was retrospectively reviewed for primary or revision, single- or multi-level ACDF procedures from 2016 to 2020. Patients lacking preoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded and analyzed using Fisher s exact test or t-test. Patient-reported outcome measures were collected preoperatively and postoperatively. Postoperative improvement from baseline scores (ΔPROM) was calculated at all postoperative timepoints. Differences in mean PROM and ΔPROM between groups and changes from baseline PROM scores within groups were assessed using student s t-test. Linear regression analyzed the impact of preoperative PHQ-9 on ΔPROM among primary and revision patients. RESULTS A total of 143 patients (121 primary and 22 revision) were included. Significant differences between groups were demonstrated at the preoperative timepoint for NDI (p=0.022). ΔPROM values did not significantly differ between groups. Regression analysis revealed significant relationships between preoperative PHQ-9 and ΔPHQ-9 at all timepoints, ΔVAS neck at 6-weeks and 6-months, ΔVAS arm at 6-months, and ΔNDI at 6-weeks and 6-months for the primary group (all p CONCLUSIONS Primary or revision ACDF procedures did not significantly differ in depressive symptoms through 1-year. Primary ACDF patients significantly improved in all PROMs through all timepoints, while revision patients had limited improvement in PROMs. Preoperative depression may have a stronger association on postoperative outcomes for primary procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.