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The effect of preoperative hospital anxiety and depression scale evaluation on the clinical outcomes following posterior lumbar interbody fusion

Year: 2026

Type: article

Abstract: Introduction: Preoperative anxiety and depression may influence outcomes in patients undergoing posterior lumbar interbody fusion (PLIF). Research question: Do elevated preoperative anxiety and/or depression affect postoperative patient-reported outcome measures (PROMs) one year after PLIF? Material and methods: Patients from an observational cohort study on smoking and PLIF, who completed one-year follow-up were included. Preoperative and one-year postoperative Hospital Anxiety and Depression Scale (HADS), Oswestry Disability Index (ODI), Numeric Rating Scale (NRS) for back- and leg pain, Five Dimensions Health Questionnaire (EQ-5D), Visual Analogue Scale (VAS) health scores and Perceived Recovery scores were assessed. Outcomes were compared between patients with normal (<13) and abnormal (≥13) HADS scores and between anxiety (HADS-A) and depression (HADS-D) subgroups. Results: Eighty-seven patients were included with a mean age of 59 years. Forty patients had normal and 47 abnormal baseline HADS scores. Patients with abnormal HADS scores reported significantly worse preoperative PROMs but achieved comparable one-year improvements. Despite comparable change scores, they continued to report worse NRS back pain, EQ-5D, HADS, and perceived recovery at one year. In the HADS-A subgroup, significant postoperative differences were observed for NRS back pain and perceived recovery. In the HADS-D subgroup, ODI, NRS back pain, and EQ-5D remained significantly worse. The proportion of patients achieving the minimum clinically important difference was similar across groups. Discussion and conclusion: PLIF provides meaningful functional improvement in patients with elevated preoperative anxiety and depression. However, these patients may experience lower postoperative status and satisfaction despite comparable improvements, highlighting the importance of preoperative patient education.

Source: Brain and Spine

DOI: 10.1016/j.bas.2026.107483

Authors: Luc W.F. van Haaster, Joep Kitzen, Gijsbert M. Overdevest, Willem Pondaag, Godard C.W. de Ruiter, Carmen L.A. Vleggeert-Lankamp