22 SPINELINE | JULY · AUGUST 2017 WWW.SPINELINE-DIGITAL.ORG
Ari S. Hilibrand; Jonathan N.
Department of Orthopaedics and
Rehabilitation, Yale University
School of Medicine
New Haven, CT, USA
Impact of Preoperative Depression on Hospital Consumer Assessment
of Healthcare Providers and Systems Survey Results in a Lumbar Fusion
Levin JM, Winkelman RD, Smith GA, Tanenbaum JE, Benzel EC, Mroz TE, Steinmetz MP
Spine 2017; 42: 675-681. PMID: 28169959. Available at: https://www.ncbi.nlm.nih.gov/
Study Design. A retrospective cohort study at a single institution.
Objective. To determine the effect of preoperative depression on Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) survey scores in a lumbar
fusion population. Summary of Background Data. HCAHPS surveys are used to assess
the quality of the patient experience, and directly influences reimbursement for hospital
systems and spine surgeons nationwide. Untreated depression has been linked to worse
functional outcomes in spine surgery. We, however, aimed to elucidate whether HCAHPS
survey responses were different in depressed patients.
Methods. Prospectively collected functional outcome data including Patient Health
Questionnaire 9, EuroQol five dimensions, and Pain Disability Questionnaire were analyzed preoperatively. Preoperative Patient Health Questionnaire 9 scores of greater than
or equal to 10 (moderate to severe depression) defined our depressed cohort of patients.
HCAHPS responses were obtained for each individual, allowing for real-world analysis
of outcomes in this population.
Results. In our 237 patient cohort, depressed patients were younger, female; were on full
disability; and had lower scores on EuroQol five dimensions and Pain Disability Questionnaire preoperatively. Approximately 73.2% of depressed patients felt doctors treated
them with respect, compared to 88.8% of patients without depression (P1⁄ 40.005). Also,
depressed patients felt nurses treated them with less respect (P1⁄ 40.014) and that physicians did not listen to them as carefully (P 1⁄ 4 0.029). Multivariate regression analysis
revealed that patients with preoperative depression had higher odds of patients feeling
less respected by both physicians and nurses. Multivariate analysis also revealed that
depression was an independent predictor of lower patient satisfaction with nursing response to their needs.
Conclusion. In patients undergoing lumbar fusion, preoperative depression was shown
to have negative effect on patient experience measured by the HCAHPS survey. These
results suggest that depression may be a modifiable risk factor for poor hospital experience.
Reprinted with permission.
Levin et al performed a retrospective institutional cohort study to evaluate the correlation
of preoperative depression (as determined by patient-reported outcome assessments)
on postoperative Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) scores for patients undergoing lumbar fusion. This is an important paper on
a timely topic.
The study evaluated 237 patients who underwent lumbar fusion surgery, had completed