Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery

Owoicho Adogwa, Scott L. Parker, David N. Shau, Stephen K. Mendenhall, Ali Bydon, Joseph S. Cheng, Anthony L. Asher, Matthew J. McGirt

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Background context: Patient satisfaction ratings are increasingly being used in health care as a proxy for quality and are becoming the focal point for several quality improvement initiatives. Affective disorders, such as depression, have been shown to influence patient-reported outcomes and self-interpretation of health status. We hypothesize that patient psychiatric profiles influence reported satisfaction with care, independent of surgical effectiveness. Purpose: To assess the predictive value of preoperative depression on patient satisfaction after revision surgery for same-level recurrent stenosis. Study design: Retrospective cohort study. Patient sample: Fifty-three patients undergoing a revision surgery for symptomatic same-level recurrent stenosis. Outcome measures: Patient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health state values (EuroQol-5D [EQ-5D]), disability (Oswestry Disability Index [ODI]), pain (visual analog scale [VAS]), depression (Zung self-rating depression scale), and Short Form 12 (SF-12) physical and mental component scores (PCS and MCS). Patient satisfaction was dichotomized as either "YES" or "NO" on whether they were satisfied with their surgical outcome 2 years after the surgery. Methods: A total of fifty-three patients undergoing revision neural decompression and instrumented fusion for same-level recurrent stenosis-associated back and leg pain were included in this study. Preoperative Zung self-rating depression score (ZDS), education status, comorbidities, and postoperative satisfaction with surgical care and outcome was assessed for all patients. Baseline and 2-year VAS for leg pain (VAS-LP), VAS for low back pain (VAS-BP), ODI, SF-12 PCS and MCS, and health-state utility (EQ-5D) were assessed. Factors associated with patient satisfaction after surgery were assessed via multivariate logistic regression analysis. Results: Two years after surgery, a significant improvement was reported in all outcome measures: VAS-BP (5±2.94 vs. 9.28±1, p<.001), VAS-LP (3.43±2.95 vs. 9.5±0.93, p<.001), ODI (21.75±12.07 vs. 36.01±6, p<.001), SF-12 PCS (32.30±11.01 vs. 25.13±5.84, p<.001), SF-12 MCS (47.48±10.96 vs. 34.91±12.77, p<.001), EQ-5D (0.60±0.31 vs. 0.18±0.22, p<.001), and ZDS (37.52±11.98 vs. 49.90±10.88, p<.001). Independent of postoperative improvement in pain and disability (surgical effectiveness), increasing preoperative Zung depression score was significantly associated with patient dissatisfaction 2 years after revision lumbar surgery (Odds ratio=0.67 [confidence interval: 0.38, 0.87], p<.001). Conclusions: Our study suggests that independent of the surgical effectiveness, the extent of preoperative depression influences the reported patient satisfaction after revision lumbar surgery. Quality improvement initiatives using patient satisfaction as a proxy for quality should account for the patients' baseline depression as potential confounders.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalSpine Journal
Issue number5
StatePublished - May 2013
Externally publishedYes


  • Clinical outcomes
  • Depression
  • Preoperative Zung
  • Revision lumbar surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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