Propensity Score-Matched Analysis of the Association Between Depression, Anxiety, and Patient-Reported Outcomes Following Lumbar Surgery.

Abstract

This study aims to evaluate the relationship between a diagnosis of depression or anxiety and postoperative patient-reported outcome measures (PROMs) following lumbar fusion surgery, utilizing minimal clinically important difference (MCID) thresholds and propensity score matching. We conducted a propensity score matched retrospective study at a single academic institution between October 2016 and February 2025, analyzing the impact of a diagnosis of depression or anxiety on PROMs following lumbar fusion surgery. Of the 207 eligible patients, 70 (33.8%) had a documented diagnosis of depression, anxiety, or both. At baseline, patients with a mental health (depression or anxiety) reported significantly worse visual analog scale (VAS) back and PROMIS-29 Pain Intensity scores. At 12 months, they continued to have significantly worse outcomes across all PROMs, including Oswestry Disability Index (P = 0.0002), VAS back (P = 0.0072), VAS leg (P = 0.0053), and PROMIS-29 Pain Intensity (P = 0.0414). MCID achievement for VAS leg was significantly lower in the mental health group (P = 0.0080). In both univariable and multivariable regression models, mental health (depression or anxiety) was associated with lower odds of achieving MCID for VAS leg pain (P = 0.004). In the propensity-matched sample (n = 122), Oswestry Disability Index remained worse in the mental health group (P = 0.0365), and MCID achievement for VAS leg was significantly reduced (P = 0.002). Patients with preoperative depression or anxiety experienced worse postoperative outcomes following lumbar fusion. Our findings suggest that mental health may be a modifiable risk factor that influences recovery and functional benefit after lumbar spine surgery.