P119. The combined influence of sleep disturbance and depression on 12-month outcomes after lumbar spine surgery

BACKGROUND CONTEXT Psychological and behavioral factors are considered major risk factors for poor outcomes after lumbar spine surgery. However, there is a need to explore the combined effects of preoperative factors such as sleep disturbance and depression. Understanding the influence of sleep disturbance and depression can inform evidence-based preoperative assessment and shared-decision making of preoperative and postoperative treatment. PURPOSE To examine the combined influence of preoperative sleep disturbance and depression on 12-month patient-reported outcomes after lumbar spine surgery. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected registry data. PATIENT SAMPLE A total of 700 patients (mean age = 60.9 years, 257 females) undergoing surgery for a primary diagnosis of disc herniation, stenosis, spondylolisthesis, pseudoarthrosis, symptomatic mechanical disc collapse, or adjacent segment disease. All patients had to have completed preoperative patient-reported measures for sleep disturbance and depression and preoperative and 12-month patient-reported outcomes. OUTCOME MEASURES Patient-reported outcomes were disability (Oswestry Disability Index) and back and leg pain intensity (0-10 Numeric Rating Scale). Outcomes were assessed at baseline and at 12 months after surgery. METHODS Preoperative sleep disturbance and depression were assessed with 4-item PROMIS short form versions. Established thresholds defined patients with moderate/severe symptoms. We conducted separate regressions to examine the influence of preoperative sleep disturbance and depression on 12-month outcomes. Regressions examined each factor with and without accounting for the other, and in combination as a 4-level variable: 1) moderate/severe sleep disturbance alone, 2) moderate/severe depression alone, 3) both moderate/severe sleep disturbance and depression, 4) no moderate/severe sleep disturbance or depression. Covariates in regression models included age, sex, race, education, insurance, body mass index, smoking status, preoperative opioid use, fusion status, revision status, and preoperative outcome score. RESULTS In independent models, preoperative sleep disturbance and depression were significantly associated with 12-month outcomes (p < 0.05). After accounting for depression, preoperative sleep disturbance remained associated with disability, while preoperative depression adjusting for sleep disturbance remained associated with all outcomes (p < 0.05). Patients reporting both moderate/severe sleep disturbance and moderate/severe depression had 12.6 points higher disability (95% CI: 7.4 to 17.8) and 1.5 points higher back (95% CI: 0.8 to 2.3) and leg pain (95% CI: 0.7 to 2.3) compared to patients without moderate/severe sleep disturbance or depression. CONCLUSIONS Preoperative sleep disturbance and depression are independent predictors of 12-month disability and pain when considered in isolation. The combination of sleep disturbance and depression impacts postoperative outcomes considerably. The high-risk group of patients with moderate/severe sleep disturbance and depression could benefit from targeted treatment strategies. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.