The Impact of Preoperative Depression on Patient Satisfaction With Spine Surgeons in the Outpatient Setting

Hammad A. Khan, BS; Nicholas M. Rabah, BS; Robert D. Winkelman, MD, MS; Jay M. Levin, MD, MBA; Thomas E. Mroz, MD; Michael P. Steinmetz, MD


Spine. 2021;46(3):184-190. 

In This Article


Seventy-two patients met criteria for moderate-to-severe preoperative depression (PHQ-9 ≥ 10) and were thereby included in the depressed cohort, whereas the remaining 347 patients were included in the non-depressed cohort. On average, patients in the depressed cohort were younger (M ± SD; 61.94 ± 13.21 vs. 67.74 ± 8.82 years, P < 0.001) and had lower self-reported overall health (P < 0.001) than patients in the non-depressed cohort (Table 1). No significant differences were observed between depressed and non-depressed cohorts for primary diagnosis (P = 0.813), survey response time (P = 0.307), time between surgery and survey completion (P = 0.223), length of stay (P = 0.950), or percentage of patients reporting improvement in PROMIS-GPH score after surgery (P = 0.291).

Our univariate analysis of CG-CAHPS survey responses revealed that depressed patients were significantly less likely to provide top-box satisfaction ratings on seven of the 10 items included in our analysis (Table 2). With regards to the physician communication domain, depressed patients were less likely to report top-box satisfaction on five of six items: Provider always showed respect for what you had to say (85.5% depressed vs. 95.3% non-depressed, P = 0.001), Provider always listened carefully to you (75% vs. 88.8%, P = 0.002), Provider always explained things in a way you could understand (73.6% vs. 89%, P = 0.001), Provider gave easy to understand information about your health questions or concerns (72.7% vs. 91.8%, P < 0.001), and Provider knew the important information about your medical history (82.6% vs. 92.4%, P=0.01). Depressed patients were also less likely to report top-box satisfaction on both items in the provider rating domain: they were less likely to be satisfied with their spine surgeon overall (73.9% vs. 90%, P < 0.001) or recommend their spine surgeon to friends and family (85.3% vs. 94.7%, P = 0.005). No significant differences were observed in responses to items in the provider access domain between depressed and nondepressed patients (Table 2).

After controlling for age, sex, tobacco use, self-reported overall health, and improvement in PROMIS-GPH score, our multivariate analysis demonstrated that preoperative depression was independently associated with lower odds of reporting top-box satisfaction on three CG-CAHPS survey items. Depressed patients had significantly lower odds of feeling that their spine surgeon explained things in an understandable manner (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.11–0.91, P = 0.032) and feeling that their spine surgeon provided easily understandable information about their health questions or concerns (OR: 0.19, 95% CI: 0.06–0.63, P = 0.007) compared to nondepressed patients. Depressed patients also had significantly lower odds of giving a top-box OPR to their spine surgeon (OR: 0.19, 95% CI: 0.06–0.63, P = 0.007) compared to nondepressed patients (Table 3).