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Peer-reviewedCC BY 4.0Brain & Spine

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

  • Luc W.F. van Haaster1
  • Joep Kitzen2
  • Gijsbert M. Overdevest3,4
  • Willem Pondaag1,5
  • Godard C.W. de Ruiter6
  • Carmen L.A. Vleggeert-Lankamp1,4
6 affiliations
  1. 1Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, the Netherlands
  2. 2Department of Orthopedics, Maasstad Hospital, Maasstadweg 21, Rotterdam, 3079 DZ, the Netherlands
  3. 3Department of Neurosurgery, HAGA Hospital, Els Borst-Eilersplein 275, The Hague, 2545 AA, the Netherlands
  4. 4Department of Neurosurgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, Hoofddorp, 2134 TM, the Netherlands
  5. 5Department of Neurosurgery, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, 2353 GA, the Netherlands
  6. 6Department of Neurosurgery, Haaglanden Medical Center, Lijnbaan 32, The Hague, 2512 VA, the Netherlands
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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.

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Cite

BibTeXRIS
BibTeX
@article{haaster2026effect,
  title = {{The effect of preoperative hospital anxiety and depression scale evaluation on the clinical outcomes following posterior lumbar interbody fusion}},
  author = {Luc W.F. van Haaster and Joep Kitzen and Gijsbert M. Overdevest and Willem Pondaag and Godard C.W. de Ruiter and Carmen L.A. Vleggeert-Lankamp},
  journal = {Brain \& Spine},
  year = {2026},
  month = oct,
  doi = {10.1016/j.bas.2026.107483},
  url = {https://doi.org/10.1016/j.bas.2026.107483},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The effect of preoperative hospital anxiety and depression scale evaluation on the clinical outcomes following posterior lumbar interbody fusion
AU  - Luc W.F. van Haaster
AU  - Joep Kitzen
AU  - Gijsbert M. Overdevest
AU  - Willem Pondaag
AU  - Godard C.W. de Ruiter
AU  - Carmen L.A. Vleggeert-Lankamp
PY  - 2026
DA  - 2026/10/17
JO  - Brain & Spine
DO  - 10.1016/j.bas.2026.107483
UR  - https://doi.org/10.1016/j.bas.2026.107483
AB  - 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.
SN  - 2772-5294
ER  -