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Hymowitz G, Hasan F, Yerramalli G, Cervoni C. Mindfulness-Based Interventions for Surgical Patients and Impact on Postoperative Outcomes, Patient Wellbeing, and Satisfaction. Am Surg 2024; 90:947-953. [PMID: 35940585 DOI: 10.1177/00031348221117025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Several psychosocial factors can impact surgical outcomes and overall patient wellbeing following surgery. Although advances in surgical interventions and pain management protocols can reduce surgical trauma and enhance recovery from surgery, additional intervention is warranted to optimize surgical outcomes and patient quality of life (QoL) in the short- and long-term. Research on mindfulness techniques suggests that mindfulness-based interventions (MBI) effectively promote health behaviors, reduce pain, and improve psychological wellbeing and QoL. Thus, there has been an increase in research evaluating the use of MBIs to improve postoperative outcomes and wellbeing in surgical patients. The authors provide a brief overview of psychosocial outcomes of surgery and MBIs and review the literature on the impact of MBIs on postoperative outcomes. The extant literature indicates that MBIs are feasible and acceptable for use in surgical patient populations and provides preliminary evidence of the benefits of mindfulness across a range of surgical patient populations. However, more research is needed to assess the long-term efficacy of MBIs delivered online and in-person across the perioperative continuum.
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Affiliation(s)
| | - Farah Hasan
- Stony Brook University, Stony Brook, NY, USA
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2
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Avramut R, Talpos S, Szuhanek C, Pricop M, Talpos R, Hajaj T, Nikolajevic-Stoican N, Maracineanu R, Ghircau-Radu R, Popa M. Male and Female Discrepancies in Anxiety, Depressive Symptoms, and Coping Strategies among Orthognathic Patients: A Cross-Sectional Analysis. J Clin Med 2023; 12:7161. [PMID: 38002773 PMCID: PMC10672552 DOI: 10.3390/jcm12227161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
With an increasing understanding of the differences between men and women's psychological experiences, this study aimed to probe the sex-based differences in anxiety, depressive symptoms, and coping strategies among orthognathic patients. The study hypothesis was that female patients would show higher levels of anxiety and depressive symptoms than males, and that coping mechanisms would differ between male and female sexes. A cross-sectional design was adopted, examining orthognathic patients from the Department of Oral and Maxillo-Facial Surgery at the Emergency Clinical Municipal Hospital in Timisoara, Romania, from 2020 to 2023. Eligible participants (18+ years with no prior orthognathic treatment) completed a comprehensive online questionnaire 6 weeks before scheduled surgery. This was composed of validated self-report instruments comprising the SF-36, GAD-7, and the PHQ-9, and the COPE-60, along with additional sociodemographic data. Of the 127 orthognathic patients analyzed (68 men and 59 women, aged 18 to 65 years, mean age 32), men rated their physical health status slightly better on the SF-36 scale. However, the most notable difference was in mental health, with females scoring higher on both the PHQ-9 (indicative of depression) and the GAD-7 (indicative of anxiety) scales. Specifically, female participants exhibited average PHQ-9 scores 1.8 points higher and GAD-7 scores 1.5 points higher than their male counterparts. Coping mechanisms also varied: 42% of male patients primarily employed "Disengagement" strategies, while 58% of females predominantly used "Engagement" and "Emotion Focused" strategies. Emotion-focused coping was associated with a 1.6-fold increased risk of depressive symptoms. Sex differences play a crucial role in the psychological experiences of orthognathic patients, evident in anxiety and depression levels, perceived health status, and coping strategies. This underlines the importance of sex-tailored psychological support in the preoperative phase for orthognathic surgery patients.
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Affiliation(s)
- Robert Avramut
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (R.A.); (N.N.-S.); (R.M.)
| | - Serban Talpos
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Revolutiei Boulevard 9, 300041 Timisoara, Romania;
| | - Camelia Szuhanek
- Discipline of Orthodontics, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Revolutiei Boulevard 9, 300041 Timisoara, Romania;
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Revolutiei Boulevard 9, 300041 Timisoara, Romania;
| | - Roxana Talpos
- Discipline of Odontotherapy-Endodontics, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Tareq Hajaj
- Discipline of Prostheses Technology and Dental Materials, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Nicoleta Nikolajevic-Stoican
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (R.A.); (N.N.-S.); (R.M.)
- Department of Pediatric Dentistry, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Raluca Maracineanu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (R.A.); (N.N.-S.); (R.M.)
| | - Roxana Ghircau-Radu
- Faculty of Dental Medicine, “Vasile Goldis” Western University of Arad, Revolutiei Boulevard 94-96, 310025 Arad, Romania;
| | - Malina Popa
- Department of Pediatric Dentistry, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Kok XLF, Gwilliam J, Sayers M, Jones EM, Cunningham SJ. A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients. J Clin Med 2023; 12:5305. [PMID: 37629347 PMCID: PMC10455953 DOI: 10.3390/jcm12165305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety.
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Affiliation(s)
- Xiu Ling Florence Kok
- Department of Orthodontics, UCL Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK;
| | - Jamie Gwilliam
- Department of Orthodontics, St George’s Hospital, St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK;
| | - Mark Sayers
- Department of Orthodontics, Queen Mary’s Hospital Sidcup, King’s College Hospital NHS Foundation Trust, Sidcup DA14 6LT, UK;
| | - Elinor M. Jones
- Department of Statistical Science, University College London, London WC1E 6BT, UK;
| | - Susan J. Cunningham
- Department of Orthodontics, UCL Eastman Dental Institute, 21 University Street, London WC1E 6DE, UK;
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Liu L, Xue H, Han Z, Jiang L, Chen L, Wang D. Comparison between OLIF and MISTLIF in degenerative lumbar stenosis: an age-, sex-, and segment-matched cohort study. Sci Rep 2023; 13:13188. [PMID: 37580586 PMCID: PMC10425456 DOI: 10.1038/s41598-023-40533-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/11/2023] [Indexed: 08/16/2023] Open
Abstract
To compare outcomes after oblique lateral interbody fusion (OLIF) versus minimally invasive transforaminal lumbar interbody fusion (MISTLIF) with bilateral decompression via unilateral approach for treating mild to moderate symptomatic degenerative lumbar spinal stenosis (DLSS). We retrospectively compared patients who underwent single-level (L4/5) OLIF with an age-, sex-, and segment-matched MISTLIF with bilateral decompression via unilateral approach cohort. Perioperative data were collected for the operative time, intraoperative blood loss, drainage in the first postoperative day, postoperative hospital stay, cost, intraoperative fluoroscopy, and complications. Lumbar radiographs were measured for changes in posterior intervertebral space height (PISH), intervertebral space foramen height (IFH), intervertebral foramen area (IFA), and area of the spinal canal (ASC). Clinical and psychological outcomes included the visual analog scale (VAS), Oswestry Disability Index (ODI), and hospital anxiety and depression scale (HADS). 35 OLIF patients were compared with 35 MISTLIF patients in L4/5 DLSS. The OLIF group had shorter bedtime, postoperative hospital stays, less intraoperative and postoperative blood loss (all P < 0.05), but had more times of intraoperative fluoroscopy, longer operative time, and higher cost (all P < 0.05). The complication rates were equivalent (OLIF vs MISTLIF: 22.86% vs 17.14%). PISH (11.94 ± 1.78 mm vs 9.42 ± 1.94 mm, P < 0.05), IFH (23.87 ± 3.05 mm vs 21.41 ± 2.95 mm, P < 0.05), and IFA (212.14 ± 51.82 mm2 vs 177.07 ± 51.73 mm2, P < 0.05) after surgery were significantly increased in the OLIF group. The ASC was increased significantly after the operation in both groups, but the ASC in the MISTLIF group was increased significantly more than that in the OLIF group (450.04 ± 66.66 mm2 vs 171.41 ± 58.55 mm2, P < 0.05). The lumbar VAS scores at 1 month (1.89 ± 0.87 vs 2.34 ± 0.84, P = 0.028) and 6 months (1.23 ± 0.97 vs 1.80 ± 0.99, P = 0.018) after operation in the OLIF group were significantly lower. There were no significant differences in lower extremity VAS and ODI scores between the two groups. Compared with MISTLIF group, HADS scores on postoperative day 3 (2.91 ± 1.46 vs 4.89 ± 1.78, P < 0.05) and prior to hospital discharge (PTD) (2.54 ± 1.38 vs 3.80 ± 1.78, P = 0.002) in the OLIF group were decreased significantly. OLIF showed more advantages of less surgical invasion, lower incidence of postoperative low back pain, faster postoperative recovery, and less anxiety compared with MISTLIF. Regardless of cost, OLIF seems to be a better option to treat mild to moderate symptomatic DLSS.
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Affiliation(s)
- Lantao Liu
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Hui Xue
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Zhiyuan Han
- Graduate School of Dalian Medical University, No. 9 West Section of Lushun South Road, Dalian, 116044, Liaoning, People's Republic of China
| | - Lianghai Jiang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Longwei Chen
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China
| | - Dechun Wang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Donghai Zhong Road No. 5, Qingdao, 266000, Shandong, People's Republic of China.
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Ki M, Kim DC, You SW, Oh J, Jang J, Yoo HH. Appropriateness of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans to measure preoperative anxiety and the effect of preoperative anxiety on postoperative quality of recovery. Anesth Pain Med (Seoul) 2023; 18:260-269. [PMID: 37691595 PMCID: PMC10410555 DOI: 10.17085/apm.23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND The reliability and validity of the anxiety subscale of the Hospital Anxiety and Depression Scale for Koreans (K-HADS-A) has not been studied in Korean surgical patients. This study aimed to validate the usefulness of K-HADS-A for measuring preoperative anxiety in Korean surgical patients. Additionally, the effect of preoperative anxiety on postoperative quality of recovery was evaluated. METHODS Preoperative anxiety in 126 inpatients with planned elective surgery was measured using the K-HADS-A. The postoperative quality of recovery was measured using the Korean version of the Quality of Recovery-15. The validity and reliability of the K-HADS-A were evaluated. The differences in quality of recovery on the first and seventh day postoperatively were then compared between the anxious and non-anxious groups. RESULTS There was a statistical correlation between the K-HADS-A and Anxiety Likert Scale. The goodness-of-fit indices of the structural equation model showed how well the data from the K-HADS-A match their concept. The Kaiser-Meyer-Olkin value was 0.848, and the P value of Bartlett's test of sphericity was < 0.001. Cronbach's alpha was high at 0.872. The K-HADS-A had an acceptable level of validity and reliability. Postoperative quality of recovery was significantly lower in the anxious group (postoperative day 1: t = 2.058, P = 0.042; postoperative day 7: t = 3.430, P = 0.002). CONCLUSIONS The K-HADS-A is an acceptable tool for appropriately assessing preoperative anxiety in Korean surgical patients. Assessing preoperative anxiety is valuable, because preoperative anxiety affects the postoperative quality of mental and physical recovery.
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Affiliation(s)
- Minjong Ki
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seon Woo You
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jeongmin Oh
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Jieun Jang
- Department of Anesthesiology and Pain Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyo Hyun Yoo
- Department of Medical Education, Jeonbuk National University Medical School, Jeonju, Korea
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Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis. Sci Rep 2022; 12:2821. [PMID: 35181747 PMCID: PMC8857319 DOI: 10.1038/s41598-022-06797-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Evidence on the role of depression and anxiety in patients undergoing surgical treatment for symptomatic degenerative lumbar spinal stenosis (DLSS) is conflicting. We aimed to assess the association between depression and anxiety with symptoms and function in patients undergoing surgery for DLSS. Included were patients with symptomatic DLSS participating in a prospective multicentre cohort study who underwent surgery and completed the 24-month follow-up. We used the hospital anxiety and depression scale (HADS) to assess depression/anxiety. We used mixed-effects models to quantify the impact on the primary outcome change in the spinal stenosis measure (SSM) symptoms/function subscale from baseline to 12- and 24-months. Logistic regression analysis was used to quantify the odds of the SSM to reach a minimal clinically important difference (MCID) at 24 months follow-up. The robustness of the results in the presence of unmeasured confounding was quantified using a benchmarking method based on a multiple linear model. Out of 401 patients 72 (17.95%) were depressed and 80 anxious (19.05%). Depression was associated with more symptoms (β = 0.36, 95% confidence interval (CI) 0.20 to 0.51, p < 0.001) and worse function (β = 0.37, 95% CI 0.24 to 0.50, p < 0.001) at 12- and 24-months. Only the association between baseline depression and SSM symptoms/function was robust at 12 and 24 months. There was no evidence for baseline depression/anxiety decreasing odds for a MCID in SSM symptoms and function over time. In patients undergoing surgery for symptomatic DLSS, preoperative depression but not anxiety was associated with more severe symptoms and disability at 12 and 24 months.
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Sharma AK, Elbuluk AM, Gkiatas I, Kim JM, Sculco PK, Vigdorchik JM. Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes. JBJS Rev 2021; 9:01874474-202107000-00013. [PMID: 34297704 DOI: 10.2106/jbjs.rvw.20.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery. » The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease. » Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.
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Affiliation(s)
- Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Julia M Kim
- Clinical Psychology, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Yu B, Zhang J, Pan J, Wang Y, Chen Y, Zhao W, Wu D. Psychological and Functional Comparison between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for Single-Level Lumbar Spinal Stenosis. Orthop Surg 2021; 13:1213-1226. [PMID: 33943023 PMCID: PMC8274193 DOI: 10.1111/os.12986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to investigate whether treatment with minimally invasive transforaminal lumbar interbody fusion (Mis‐TLIF) causes patients suffering from lumbar spinal stenosis (LSS) to experience less anxiety and better clinical efficacy than open transforaminal lumbar interbody fusion (TLIF). Methods In this retrospective cohort study, we analyzed 86 patients, including 46 male patients and 41 female patients, who suffered from single‐segmental lumbar spinal stenosis in our department between January 2016 and January 2018. They were divided into two groups: a control group (n = 46), for patients who underwent open TLIF surgery, and an experimental group (n = 40), for patients who underwent Mis‐TLIF surgery. All patients were evaluated based on operation time, intraoperative blood loss, hospital stay, visual analogue scale (VAS), Oswestry disability index (ODI), hospital anxiety depression scale (HADS), fusion rate, and complications (screw misplacement and loosening, cerebrospinal fluid leakage, infection, and delayed wound healing). Patient characteristics were compared within and between groups. Results The average incision length was 3.64 ± 0.476 cm in the experimental group, which was smaller than that (8.11 ± 2.406 cm) in the control group (P < 0.05). The operation time of the experimental group was a little longer than that of the control group. The intraoperative blood loss and hospital stay in the experimental group were less than those in the control group. The mean preoperative low back pain VAS score was 7.525 ± 1.432 in the experimental group and 7.087 ± 1.799 in the control group (P > 0.05). The low back pain VAS scores on postoperative day 3 and at 3, 6, and 12 months postoperatively were 5.000 ± 0.987, 4.075 ± 0.997, 2.150 ± 0.834, and 1.450 ± 0.639 in the experimental group, respectively; these scores were lower than those in the control group (6.870 ± 1.572, P < 0.05; 4.630 ± 1.103, P < 0.05; 2.630 ± 1.103, P < 0.05; and 2.326 ± 1.034, P < 0.05, respectively). There was no obvious difference in the leg pain VAS scores between the two groups at all follow‐up points. The mean preoperative ODI score was 58.700% ± 19.703% in the experimental group and 61.696% ± 17.583% in the control group (P > 0.05). The ODI scores at postoperative months 3, 6, and 12 were 25.225% ± 5.554%, 20.150% ± 7.698%, and 16.125% ± 9.565% in the experimental group; these scores were lower than those in the control group (49.130% ± 14.805%, P < 0.05; 34.044% ± 15.148%, P < 0.05; and 29.282% ± 132.567%, P < 0.05, respectively). The mean preoperative HADS score was 14.475 ± 3.113 in the experimental group and 13.391 ± 2.824 in the control group (P > 0.05). However, the mean HADS scores on postoperative day 3 in the experimental group was 8.500 ± 2.000, decreasing obviously compared to the preoperative scores (P < 0.05). The mean postoperative HADS score on postoperative day 3 in the control group was 12.734 ± 1.949, which had not decreased significantly compared to the preoperative score (P > 0.05). The HADS scores in the experimental group was lower than that in the control group on postoperative day 3 (P < 0.05). In the correlation analysis, the incision length was correlated to the HADS scores on postoperative day 3 (r = 0.527, P < 0.05). The HADS scores on postoperative day 3 were positively correlated with the low back pain VAS scores on the same day (r = 0.388, P < 0.05). The HADS scores on postoperative day 3were positively correlated with the ODI scores at 3‐month (r = 0.460, P < 0.05), 6‐month (r = 0.429, P < 0.05), and 12‐month follow up (r = 0.349, P < 0.05). Fusion rates were not significantly different between the two groups. There was no screw misplacement and loosening, infection, or delayed wound healing in either group. The cerebrospinal fluid leakage rate in the control group was higher than that in the experimental group. Conclusion Patients undergoing Mis‐TLIF experience less anxiety and have better outcomes than those who undergo open TLIF. The lower level of anxiety experienced by patients undergoing Mis‐TLIF is positively correlated with postoperative VAS and ODI scores.
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Affiliation(s)
- Bin Yu
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin Zhang
- Shanghai East Hospital, Nanjing Medical University, Shanghai, China
| | - Jie Pan
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yizhou Wang
- Nanjing Medical University, Changshu No. 2 People's Hospital, Suzhou, Changshu, China
| | - YingGao Chen
- Department of Neurosurgery, Shantou Central Hospital, Shantou, China
| | - Weidong Zhao
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Sargın M, Uluer M. The effect of pre-procedure anxiety on sedative requirements for sedation during upper gastrointestinal endoscopy. Turk J Surg 2021; 36:368-373. [PMID: 33778396 DOI: 10.47717/turkjsurg.2020.4532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022]
Abstract
Objectives Sedation for upper gastrointestinal endoscopy, commonly used for diagnosis and treatment of gastrointestinal diseases, has been increasing widespread. Sedative agent requirements during sedation or anesthesia can be affected by many factors such as age and sex. In the present study, we aimed to evaluate the effects of pre-procedural anxiety levels on sedative requirements during upper gastrointestinal endoscopy. Material and Methods 300 patients between the ages of 18-70 years were studied. Baseline anxiety levels were measured before the procedure using Spielberger's State-Trait Anxiety Inventory (STAI) form X1. Propofol was administered to have BIS values between 65-85 during sedation. Doses of propofol, total procedure time, satisfaction of the patients and endoscopists and BIS values were recorded. Results Pre-procedural anxiety was 44 (40-48 [20-70]). We found significant correlations between pre-procedure anxiety and the usage of propofol (mg, mg/kg, mg/kg/dk) at BIS values between 65-85, [respectively, (p= 0.451, p <0.001), (p= 0.455, p <0.001), (p= 0.428, p <0.001)]. No correlation was found between pre-procedure anxiety and procedural or sedation complications (respectively p= 0.111, p= 0.424 and p= 0.408, p= 0.363). We found significant negative correlations between pre-procedure anxiety and the satisfaction of the patients/endoscopist [respectively, (p= -0.477, p <0.001), (p= -0.495, p <0.001)]. Conclusion Based on the results of this study, we suggest that there is a significant association between the pre-procedural anxiety levels and use of sedative drugs in patients undergoing upper gastrointestinal endoscopy.
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Affiliation(s)
- Mehmet Sargın
- Department of Anesthesiology and Reanimation, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Mehmet Uluer
- Clinic of Anesthesiology and Reanimation, Konya Training and Research Hospital, Konya, Turkey
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10
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Christian Z, Afuwape O, Johnson ZD, Adeyemo E, Barrie U, Dosselman LJ, Pernik MN, Hall K, Aoun SG, Bagley CA. Evaluating the Impact of Psychiatric Disorders on Preoperative Pain Ratings, Narcotics Use, and the PROMIS-29 Quality Domains in Spine Surgery Candidates. Cureus 2021; 13:e12768. [PMID: 33614357 PMCID: PMC7888361 DOI: 10.7759/cureus.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective We aimed to study the relationship between psychiatric Disorders (PD), preoperative pain, and opioid medication intake, as well as the quality of life patient-reported outcome measures using the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) questionnaire, during the 30-day interval preceding surgery, in a consecutive series of patients who were scheduled to undergo surgical spine procedures. We hypothesized that PD could affect preoperative narcotic use and pain interference in a fashion that was not linearly associated with preoperative pain in spine surgery candidates. Methods The records of consecutive adult patients who underwent elective spinal surgery between October 2016 and August 2017 at a single institution were reviewed. We included patients who underwent preoperative pain assessment within 30 days prior to their planned surgery using the PROMIS-29 questionnaire. Patients with PD were compared to controls. Results A total of 117 patients matched our criteria. The average rating of pain intensity was notably higher in the PD group as compared to controls (p=0.004). The PD group had more patients complaining of high pain levels (>6) as compared to the control group (p=0.026). Controls with high pain levels had a greater incidence of preoperative narcotic use as compared to the low-pain cohort (p=0.029). However, there was no difference in the actual dose of daily narcotic medication taken between the PD and control groups (P=0.099) or between the low- and high pain score groups in the control (p=0.291) and PD (p=0.441) groups, respectively. Patients with PD and higher pain ratings seemed to have a higher incidence of anxiety (p=0.005) and depression (p<0.001). That was not the case for controls. Conclusions PDs may impact the degree of preoperative pain interference and the intake of narcotic medication independently from pain intensity ratings.
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Affiliation(s)
- Zachary Christian
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Olusoji Afuwape
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Zachary D Johnson
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Emmanuel Adeyemo
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Umaru Barrie
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Luke J Dosselman
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Mark N Pernik
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Kristen Hall
- Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Salah G Aoun
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Carlos A Bagley
- Neurosurgery, University of Texas Southwestern Medical Center, Dallas, USA
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Development of the "Core Yellow Flags Index" (CYFI) as a brief instrument for the assessment of key psychological factors in patients undergoing spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1935-1952. [DOI: 10.1007/s00586-020-06462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/10/2020] [Indexed: 12/21/2022]
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12
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Dhawan A. Editorial Commentary: Surgeons Should Not "Underpromise" to "Overdeliver": High Preoperative Patient Expectations Correlate With Improved Orthopaedic Surgical Outcomes. Arthroscopy 2019; 35:3259-3260. [PMID: 31785754 DOI: 10.1016/j.arthro.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 02/02/2023]
Abstract
Despite our understanding of patient-specific, anatomic, and surgical factors that can influence surgical outcomes, there remains a significant amount of variability in patient satisfaction and outcome after any orthopaedic surgical procedure. This variability is in large part due to psychosocial factors. There is a growing volume of literature demonstrating the importance of psychosocial factors to include anxiety, depression, attitudinal factors, expectations, patient-perceived control, self-efficacy, knowledge, and expectations. Many of these factors are modifiable, and it is critical that we as providers understand the depth and breadth of these psychosocial factors, and their influence, on our patient's surgical outcomes. Surgeons should not "underpromise" to "overdeliver," because high preoperative patient expectations have a positive predictive value for improved orthopaedic surgical outcomes.
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Määttä J, Martikainen A, Ikäheimo TM, Nissen M, Viinamäki H, von Und Zu Fraunberg M, Huttunen J. Benzodiazepine Use Is Associated With Poorer Spinal Cord Stimulation Outcome in 373 Neuropathic Pain Patients. Neuromodulation 2019; 23:646-652. [PMID: 31508883 DOI: 10.1111/ner.13045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/22/2019] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study is to investigate whether benzodiazepine use differs between patients with favorable and unfavorable spinal cord stimulation (SCS) treatment outcome. We hypothesize that the patients with unfavorable SCS outcome would exhibit a higher level of benzodiazepine use. MATERIALS AND METHODS Using a case-control study setting, we examined benzodiazepine use in SCS patients and in matched population controls as a potential risk factor poor SCS outcome. A total of 373 consecutive SCS patients treated in Kuopio University Hospital between 1997 and 2014 and their 1117 matched population controls were followed until patient death or the end of March 2016. RESULTS Benzodiazepines were used during the 24-month period before or after SCS implantation by 42.3% of the SCS patients who had the device explanted, 39.5% who had an unsuccessful trial stimulation, 28.0% who still had the device at the end of the follow-up period, and 8.0% of the controls. Diazepam use before SCS increased the odds for explanting of SCS by 2.4-fold (95% Cl: 1.0-5.4). Starting clonazepam use after SCS was associated with a 5.2-fold (95% CI: 1.5-18.9) increase in the odds of unsuccessful trial stimulation. CONCLUSION The benzodiazepine use in patients with poor SCS outcome illustrates the role of anxiety in SCS outcomes and the need for multidisciplinary treatment of pain.
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Affiliation(s)
- Jaakko Määttä
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Antti Martikainen
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Tiina-Mari Ikäheimo
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mette Nissen
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heimo Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, KUH Neurocenter, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Petrowski K, Ritzka D, Fröhner P, Leimert M. Psychosocial Stress Reactivity as Predictor of Operative Outcome in Lumbar Disc Surgery. World Neurosurg 2019; 129:e436-e443. [PMID: 31150852 DOI: 10.1016/j.wneu.2019.05.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND A large proportion of the population suffers from chronic back pain. For optimal treatment, the question arises which patients would benefit from conservative therapy and for whom lumbar disc surgery is most appropriate. It seems reasonable to analyze the impact of paraclinical parameters on the operation outcome to identify patients who would benefit less from surgery or need special pre-/postoperative medical care. MATERIALS AND METHODS From March 2012 to July 2014, 32 patients were treated via microscopically supported interlaminar fenestration and discectomy at the Department of Neurosurgery, University Hospital Carl Gustav Carus Dresden. One day before the operation, a cortisol survey was made during the stress response of the Trier Social Stress Test. At the same time, a survey of relevant questionnaires was conducted by which the postoperative symptom experience was made operational and comparable with the evaluation of the same information thirty days afterwards. RESULTS It could be shown that there is a connection between cortisol reactivity and the pain burden following operations. Patients with a greater cortisol reaction under stress exposition partially experienced more intense postoperative pain than the patients with a lower cortisol reaction. However, this relationship could only be explained by single significant results, whereas further calculations could not produce any significance. CONCLUSIONS Cortisol reactivity seems to be associated with pain development. The inconsistent findings in empiricism as well as in this investigation are indicative of a complex association of postoperative pain and cortisol reactivity, which needs to be examined further.
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Affiliation(s)
- Katja Petrowski
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany; Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Dresden, Germany.
| | - Desiree Ritzka
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany; Department of Psychology and Psychotherapy, University Witten/Herdecke, Witten, Germany
| | - Patrick Fröhner
- Medical Psychology and Medical Sociology, Clinic and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medicine Mainz, Mainz, Germany
| | - Mario Leimert
- Asklepios Orthopedic Clinic Hohwald, Interdisciplinary Spine Center, Hohwald, Germany
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Elsamadicy AA, Charalambous L, Adil SM, Drysdale N, Lee M, Koo AB, Chouairi F, Kundishora AJ, Camara-Quintana J, Qureshi T, Kolb L, Laurans M, Abbed K, Karikari IO. Reduced Influence of Affective Disorders on 6-Week and 3-Month Narcotic Refills After Primary Complex Spinal Fusions for Adult Deformity Correction: A Single-Institutional Study. World Neurosurg 2019; 129:e311-e316. [PMID: 31132486 DOI: 10.1016/j.wneu.2019.05.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Previous studies have identified the impact of affective disorders on preoperative and postoperative perception of pain. However, there is a scarcity of data identifying the impact of affective disorders on postdischarge narcotic refills. The aim of this study was to determine whether patients with affective disorders have more narcotic refills after complex spinal fusion for deformity correction. METHODS The medical records of 121 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (≥5 level) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative complication rates, baseline and postoperative patient-reported pain scores, ambulatory status, and narcotic refills were collected for each patient. The primary outcome was the rate of 6-week and 3-month narcotic refills. RESULTS Of the 121 patients, 43 (35.5%) had a clinical diagnosis of anxiety or depression (affective disorder) (AD n = 43; No-AD n = 78). Preoperative narcotic use was significantly higher in the AD cohort (AD 65.9% vs. No-AD 37.7%, P = 0.0035). The AD cohort had significantly higher pain scores at baseline (AD 6.5 ± 2.9 vs. No-AD 4.7 ± 3.1, P = 0.004) and at the first postoperative pain score reported (AD 6.7 ± 2.6 vs. No-AD 5.6 ± 2.9, P = 0.049). However, there were no significant differences in narcotic refills at 6 weeks (AD 34.9% vs. No-AD 25.6%, P = 0.283) and 3 months (AD 23.8% vs. No-AD 17.4%, P = 0.411) after discharge between the cohorts. CONCLUSIONS Our study suggests that whereas spinal deformity patients with affective disorders may have a higher baseline perception of pain and narcotic use, the impact of affective disorders on narcotic refills at 6 weeks and 3 months may be minimal after complex spinal fusion.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Lefko Charalambous
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Syed M Adil
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Nicolas Drysdale
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Megan Lee
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Fouad Chouairi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Tariq Qureshi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Maxwell Laurans
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Khalid Abbed
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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Singh D, Yadav JS, Jamuda BK, Singh P. Oral Pregabalin as Premedication on Anxiolysis and Stress Response to Laryngoscopy and Endotracheal Intubation in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Double-Blind Study. Anesth Essays Res 2019; 13:97-104. [PMID: 31031488 PMCID: PMC6444940 DOI: 10.4103/aer.aer_12_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Direct laryngoscopy and tracheal intubation lead to increase in heart rate and blood pressure. This can cause serious complications in patients with coronary artery disease, reactive airways, or intracranial neuropathology. Preoperative anxiety is associated with greater level of postoperative pain. Attenuation of anxiety and hemodynamic response to laryngoscopy and intubation are cornerstone of better anesthetic outcome. Gabapentinoids (gabapentin and pregabalin) have been known to possess anxiolytic, analgesic, and anticonvulsant properties. Aim The aim of this study is to determine the effects of oral pregabalin on anxiolysis and attenuation of stress response to laryngoscopy and endotracheal intubation. Study Design This was a prospective randomized double-blind placebo controlled study. Materials and Methods A total of 60 patients ASA physical status Class I and II, undergoing elective laparoscopic cholecystectomy, were randomly allocated into two groups receiving either oral placebo or oral pregabalin 150 mg, 60 min before induction of anesthesia. Visual analog scale (VAS) for anxiety was recorded before, and 60 min after giving the drug. Hemodynamic parameters (heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure) were recorded before, and 60 min after giving drug, during and 2, 4, 6, 8, and 10 min after intubation. Results During preinduction, pregabalin showed a decrease in VAS and attenuation of stress response to laryngoscopy and intubation compared to that of placebo. The premedicated patients were hemodynamically stable perioperatively without side effects. Conclusion Pregabalin is effective in attenuating preoperative anxiety and stress response to endotracheal intubation.
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Affiliation(s)
- Dheer Singh
- Department of Anesthesia and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Jaybrijesh Singh Yadav
- Department of Anesthesia and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Birendra Kumar Jamuda
- Department of Anesthesia and Critical Care, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Pooja Singh
- Department of Anesthesia, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity: Do Dementia Patients Have More Complications? Spine (Phila Pa 1976) 2018; 43:1038-1043. [PMID: 29227363 DOI: 10.1097/brs.0000000000002517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of a prospectively collected, national inpatient hospital database. OBJECTIVE We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes. SUMMARY OF BACKGROUND DATA Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity-related self-image. METHODS The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications. RESULTS A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer. CONCLUSION Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks. LEVEL OF EVIDENCE 2.
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Strøm J, Bjerrum MB, Nielsen CV, Thisted CN, Nielsen TL, Laursen M, Jørgensen LB. Anxiety and depression in spine surgery-a systematic integrative review. Spine J 2018; 18:1272-1285. [PMID: 29649613 DOI: 10.1016/j.spinee.2018.03.017] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/15/2018] [Accepted: 03/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. PURPOSE We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. STUDY DESIGN An integrative literature review was carried out. METHODS The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings. RESULTS Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health. CONCLUSIONS Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.
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Affiliation(s)
- Janni Strøm
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark.
| | - Merete B Bjerrum
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Claus V Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark
| | - Cecilie N Thisted
- Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark
| | - Tove L Nielsen
- Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark; DEFACTUM, Central Denmark Region, P.P. Ørumsgade 9-1, Building 1B Aarhus C, 8000, Denmark; Department of Occupational Therapy, VIA University College, Hedeager 2 Aarhus N, 8200, Denmark
| | - Malene Laursen
- Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark
| | - Lene B Jørgensen
- Department of Clinical Medicine, Aarhus University, PalleJuul-Jensens Boulevard 82, Aarhus N, 8200, Denmark; Regional Hospitals of Central Denmark Region, Heibergsalle 1-4, 8800, Viborg, 8800, Denmark
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Qureshi R, Werner B, Puvanesarajah V, Horowitz JA, Jain A, Sciubba D, Shen F, Hassanzadeh H. Factors Affecting Long-Term Postoperative Narcotic Use in Discectomy Patients. World Neurosurg 2018; 112:e640-e644. [PMID: 29374606 DOI: 10.1016/j.wneu.2018.01.113] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy. METHODS The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery. RESULTS Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9). CONCLUSIONS Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period.
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Affiliation(s)
- Rabia Qureshi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Brian Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jason A Horowitz
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Francis Shen
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
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Aust H, Rüsch D, Schuster M, Sturm T, Brehm F, Nestoriuc Y. Coping strategies in anxious surgical patients. BMC Health Serv Res 2016; 16:250. [PMID: 27406264 PMCID: PMC4941033 DOI: 10.1186/s12913-016-1492-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022] Open
Abstract
Background Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety. Methods We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Amsterdam Preoperative Anxiety and Information Scale/Visual Analogue Scale). In the subsample of patients with high preoperative anxiety, patients’ dispositional coping style was determined and patients’ coping efforts were studied by having patients rate their agreement with 9 different coping efforts on a four point Likert scale. Statistical analysis included correlational analysis between dispositional coping styles, coping efforts and other variables such as sociodemographic data. Statistical significance was considered for p < 0.05. Results The final analysis included 1205 patients with high preoperative anxiety. According to the initial self-assessment, about two thirds of the patients believed that information would help them to cope with their anxiety (“monitors”); the remainder declined further education/information and reported self-distraction to be most helpful to cope with anxiety (“blunters”). There was no significant difference between these two groups in anxiety scores. Educational conversation was the coping effort rated highest in monitors whereas calming conversation was the coping effort rated highest in blunters. Coping follows no demographic rules but is influenced by the level of education. Anxiolytic Medication showed no reliable correlation to monitoring and blunting disposition. Both groups showed an exactly identical agreement with this coping effort. Demand for medical anxiolysis, blunting or the desire for more conversation may indicate increased anxiety. The use of the internet was independent of the anxiety level and the demand of information. Conclusion Conversation with medical staff proved to be the most popular coping strategy. Acknowledgment of the division between information-seeking and blunting-like personalities is central to supporting the patient’s individual coping efforts. Internet access may be the easiest way to support coping today. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1492-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hansjoerg Aust
- Department of Anesthesiology and Intensive Care; Philipps-University of Marburg, Baldingerstrasse, D-35033, Marburg, Germany.
| | - Dirk Rüsch
- Department of Anesthesiology and Intensive Care; Philipps-University of Marburg, Baldingerstrasse, D-35033, Marburg, Germany
| | - Maike Schuster
- Philipps-University of Marburg (UKGM StO Marburg), Marburg, Germany
| | - Theresa Sturm
- Philipps-University of Marburg (UKGM StO Marburg), Marburg, Germany
| | - Felix Brehm
- Philipps-University of Marburg (UKGM StO Marburg), Marburg, Germany
| | - Yvonne Nestoriuc
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Pretreatment of Anxiety Before Cervical Spine Surgery Improves Clinical Outcomes: A Prospective, Single-Institution Experience. World Neurosurg 2016; 88:625-630. [DOI: 10.1016/j.wneu.2015.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 10/31/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
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Hudson BF, Ogden J. Exploring the Impact of Intraoperative Interventions for Pain and Anxiety Management During Local Anesthetic Surgery-A Systematic Review and Meta-Analysis. J Perianesth Nurs 2015; 31:118-33. [PMID: 27037166 DOI: 10.1016/j.jopan.2014.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/19/2014] [Accepted: 11/10/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE To compare the effectiveness of audiovisual and relaxation-based intraoperative interventions for their impact on intraoperative pain and anxiety. DESIGN Systematic review and meta-analysis. METHODS The following databases were searched for articles published between 1990 and January 2014: MEDLINE, PsychINFO, CINAHL, and Web of Science. Twenty randomized trials meeting the following inclusion criteria were included; adult participants undergoing elective outpatient surgery under local anesthetic using a form of distraction-based intraoperative intervention for the management of anxiety and pain. FINDING Thirty percent of studies reviewed found that intraoperative interventions improved patient experience in comparison to treatment as usual, 20% of studies were inconclusive, and 50% of studies found that interventions during surgery provided no benefit. CONCLUSIONS Both relaxation-based and audiovisual interventions were found to be efficacious for pain and anxiety management during surgery under local anesthetic. This review indicates that relaxation-based interventions could be more effective than audiovisual interventions for managing intraoperative anxiety.
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Wilson CJ, Mitchelson AJ, Tzeng TH, El-Othmani MM, Saleh J, Vasdev S, LaMontagne HJ, Saleh KJ. Caring for the surgically anxious patient: a review of the interventions and a guide to optimizing surgical outcomes. Am J Surg 2015; 212:151-9. [PMID: 26138522 DOI: 10.1016/j.amjsurg.2015.03.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/18/2015] [Accepted: 03/29/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Preoperative surgical anxiety is an unpleasant and common reaction exhibited by patients who are scheduled for surgical procedures. Beyond emotional effects on the patient, it can also have negative repercussions on the surgery including longer hospital stays and poorer outcomes. Given the widespread impacts of preoperative anxiety, it is critical for surgeons to gain a better understanding of how to identify and reduce surgical anxiety in their patients. DATA SOURCES This study used the PubMed database to review the current literature to evaluate screening tools and interventions for surgically anxious patients. CONCLUSIONS Psychiatric anxiety surveys are currently the most appropriate form of assessment for surgical anxiety. Patient education is important for preventing and reducing anxiety levels in patients. Both nonpharmacological and pharmacological interventions have been shown to be effective in reducing patient anxiety and treatment should be based on patient preference, resources available, and the surgeon's experience.
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Affiliation(s)
- Craig J Wilson
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Andrew J Mitchelson
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Mouhanad M El-Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jasmine Saleh
- National Institute on Deafness and other Communicable Disorders, National Institute of Health, Bethesda, MD, USA
| | - Sonia Vasdev
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Hillary J LaMontagne
- Department of Psychiatry, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
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The effect of intraoperative sounds of saw and hammer on psychological condition in patients with total knee arthroplasty: prospective randomized study. ScientificWorldJournal 2015; 2015:690569. [PMID: 25793222 PMCID: PMC4352437 DOI: 10.1155/2015/690569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures.
Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.
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Chong JT, Klausner AP, Petrossian A, Byrne MD, Moore JR, Goetz LL, Gater DR, Mayer Grob B. Pre-procedural antibiotics for endoscopic urological procedures: Initial experience in individuals with spinal cord injury and asymptomatic bacteriuria. J Spinal Cord Med 2015; 38:187-92. [PMID: 24621035 PMCID: PMC4397200 DOI: 10.1179/2045772313y.0000000185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the safety, efficacy, quality-of-life impact, and costs of a single dose or a longer course of pre-procedural antibiotics prior to elective endoscopic urological procedures in individuals with spinal cord injury and disorders (SCI/D) and asymptomatic bacteriuria. DESIGN A prospective observational study. SETTING Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA. PARTICIPANTS Sixty persons with SCI/D and asymptomatic bacteriuria scheduled to undergo elective endoscopic urological procedures. INTERVENTIONS A single pre-procedural dose of antibiotics vs. a 3-5-day course of pre-procedural antibiotics. OUTCOME MEASURES Objective and subjective measures of health, costs, and quality of life. RESULTS There were no significant differences in vital signs, leukocytosis, adverse events, and overall satisfaction in individuals who received short-course vs. long-course antibiotics. There was a significant decrease in antibiotic cost (33.1 ± 47.6 vs. 3.6 ± 6.1 US$, P = 0.01) for individuals in the short-course group. In addition, there was greater pre-procedural anxiety (18 vs. 0%, P < 0.05) for individuals who received long-course antibiotics. CONCLUSION SCI/D individuals with asymptomatic bacteriuria may be able to safely undergo most endoscopic urological procedures with a single dose of pre-procedural antibiotics. However, further research is required and even appropriate pre-procedural antibiotics may not prevent severe infections.
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Affiliation(s)
- Julio T. Chong
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Adam P. Klausner
- Correspondence to: Adam P. Klausner, Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, PO Box 980118, Richmond, VA 23298-0118, USA.
| | - Albert Petrossian
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Michael D. Byrne
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jewel R. Moore
- Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
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Lee JS, Park YM, Ha KY, Cho SW, Bak GH, Kim KW. Preoperative anxiety about spinal surgery under general anesthesia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:698-707. [PMID: 25670066 DOI: 10.1007/s00586-015-3788-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE No study has investigated preoperative anxiety about spinal surgery under general anesthesia. The purposes of this study were (1) to determine how many patients have preoperative anxiety about spinal surgery and general anesthesia, (2) to evaluate the level of anxiety, (3) to identify patient factors potentially associated with the level of anxiety, and (4) to describe the characteristics of the anxiety that patients experience during the perioperative period. METHODS This study was performed in 175 consecutive patients undergoing laminectomy for lumbar stenosis or discectomy for herniated nucleus pulposus under general anesthesia. Demographic data, information related to surgery, and characteristics of anxiety were obtained using a questionnaire. The level of anxiety was assessed using a visual analog scale of anxiety (VAS-anxiety). Patient factors potentially associated with the level of anxiety were investigated using multiple stepwise regression analysis. RESULTS Of 157 patients finally included in this study, 137 (87%) had preoperative anxiety (VAS-anxiety > 0). The mean VAS-anxiety score for spinal surgery was significantly higher than that for general anesthesia (4.6 ± 3.0 vs. 3.2 ± 2.7; P < 0.001). Sex and age were significant patient factors related to the level of anxiety about spinal surgery (P = 0.009) and general anesthesia (P = 0.018); female patients had a higher level of anxiety about spinal surgery, and elderly patients had a higher level of anxiety about general anesthesia. The most helpful factors in overcoming anxiety before surgery and in reducing anxiety after surgery were faith in the medical staff (48.9 %) and surgeon's explanation of the surgery performed (72.3%), respectively. CONCLUSIONS Patients awaiting laminectomy or discectomy feared spinal surgery more than general anesthesia. This study also found that medical staff and surgeons play important roles in overcoming and reducing patient anxiety during the perioperative period.
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Affiliation(s)
- Jun-Seok Lee
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Yong-Moon Park
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kee-Yong Ha
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Wook Cho
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Geun-Hyeong Bak
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea
| | - Ki-Won Kim
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouido-dong, Youngdeungpo-ku, Seoul, 150-010, Korea.
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Predictors of Acute Postsurgical Pain and Anxiety Following Primary Total Hip and Knee Arthroplasty. THE JOURNAL OF PAIN 2013; 14:502-15. [DOI: 10.1016/j.jpain.2012.12.020] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/15/2012] [Accepted: 12/31/2012] [Indexed: 11/20/2022]
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Kerper LF, Spies CD, Lößner M, Salz AL, Tafelski S, Balzer F, Weiß-Gerlach E, Neumann T, Lau A, Glaesmer H, Brähler E, Krampe H. Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up. PLoS One 2012; 7:e51167. [PMID: 23227250 PMCID: PMC3515556 DOI: 10.1371/journal.pone.0051167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/29/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. METHODS A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. RESULTS 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. CONCLUSION In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.
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Affiliation(s)
- Léonie F. Kerper
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Claudia D. Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Maria Lößner
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Anna-Lena Salz
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Felix Balzer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Edith Weiß-Gerlach
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Tim Neumann
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Alexandra Lau
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – University Medicine Berlin, Berlin, Germany
- * E-mail:
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Chung KC, Juang SE, Lee KC, Hu WH, Lu CC, Lu HF, Hung KC. The effect of pre-procedure anxiety on sedative requirements for sedation during colonoscopy. Anaesthesia 2012; 68:253-9. [PMID: 23167579 DOI: 10.1111/anae.12087] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2012] [Indexed: 11/30/2022]
Abstract
This study investigated the effects of pre-procedural anxiety (assessed using the Beck Anxiety Inventory) on sedative requirements in 135 patients undergoing sedation for colonoscopy. Deep sedation was defined as loss of consciousness and no response to colonoscopy, and was achieved by target-controlled infusion of propofol. Patients' characteristics, baseline haemodynamic profiles, Beck Anxiety Inventory scores, effect-site propofol concentration at loss of consciousness and characteristics of recovery were recorded. No correlations were found between Beck Anxiety Inventory scores and effect-site propofol concentration at loss of consciousness or baseline haemodynamic profiles. There was no statistical difference in the characteristics of recovery among patients with different levels of anxiety. In conclusion, in patients receiving deep sedation for colonoscopies, the level of pre-procedural anxiety did not relate to the sedative requirement or post-procedural recovery characteristics.
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Affiliation(s)
- K-C Chung
- Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.
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Post-operative Changes of Cerebral Glucose Metabolism in Patients with Lumbar Spinal Stenosis with Pre-operative Anxiety: Statistical Parametric Mapping Analysis of F-18 FDG Brain PET. Asian Spine J 2011; 5:117-24. [PMID: 21629487 PMCID: PMC3095801 DOI: 10.4184/asj.2011.5.2.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/16/2010] [Accepted: 06/27/2010] [Indexed: 11/21/2022] Open
Abstract
Study Design A prospective study. Purpose To assess postoperative changes in cerebral glucose metabolism in anxiety patients with lumbar spinal stenosis (SS). Overview of Literature Although an association between preoperative anxiety and abnormal cerebral glucose metabolism
may exist, only a limited number of studies using F-18 fluorodeoxyglucose positron emission tomography (FDG PET) have
evaluated preoperative to postoperative changes in cerebral glucose metabolism in SS patients in detail. Methods The present study was designed to assess preoperative to postoperative changes in cerebral glucose metabolism in anxiety patients with SS. F-18 FDG PET with statistical parametric mapping analyses was used to compare preoperative and postoperative regional brain glucose metabolism in 18 SS patients. Results F-18 FDG PET scans showed postoperative activation of several brain clusters in gray matter. These included left parahippocampus, left cerebellar tonsil, left inferior semi-lunar lobule, and right cerebellar tonsil. Areas that were deactivated postoperatively were the right insula, left fusiform gyrus, left orbitofrontal cortex, left inferior frontal gyrus, left middle frontal gyrus, left precuneus, and left inferior frontal gyrus. Conclusions SS patients with preoperative anxiety showed altered cerebral glucose metabolism at postoperative follow-up.
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Bringuier S, Dadure C, Raux O, Dubois A, Picot MC, Capdevila X. The Perioperative Validity of the Visual Analog Anxiety Scale in Children: A Discriminant and Useful Instrument in Routine Clinical Practice to Optimize Postoperative Pain Management. Anesth Analg 2009; 109:737-44. [DOI: 10.1213/ane.0b013e3181af00e4] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bayar A, Tuncay I, Atasoy N, Ayoğlu H, Keser S, Ege A. The effect of watching live arthroscopic views on postoperative anxiety of patients. Knee Surg Sports Traumatol Arthrosc 2008; 16:982-7. [PMID: 18566798 DOI: 10.1007/s00167-008-0576-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
Abstract
Surgery is a stressful experience. Many minor interventions have been shown to cause considerable anxiety in patients, but whether arthroscopy leads to such anxiety is not well-known. Methods for lowering perioperative anxiety have been sought and listening to music or watching a movie have been recommended. The method of permitting patients to watch their own endoscopy has been studied infrequently. Our aim in this study was to find out the effect of watching simultaneous arthroscopic views on postoperative anxiety. A total of 63 patients were randomly divided into two groups: those watching their own arthroscopy formed group W, while patients that were only verbally informed formed group NW. The mean age of patients in both groups were 33 and 34, respectively. Meniscal surgery was the most commonly performed procedure (49/63 patients). The patients filled in state scale of State-trait anxiety inventory (STAI) forms and the study questionnaire (SQ) prepared for this study, just before and after the arthroscopy. Group W had significantly lower postoperative scores of STAI-S, whole questionnaire (Q-score) and all but one of individual statements in SQ. Having a previous operation history did not affect STAI scores. Age and level of education was not correlated with any of the studied parameters either. The ratio of patients that were pleased with the arthroscopy experience in group W and NW were 94 and 63%, respectively. Watching live arthroscopic views has led to a significant decrease in postoperative anxiety and worries about the surgery and the postoperative period, while increasing overall understanding and satisfaction of the patient.
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Affiliation(s)
- Ahmet Bayar
- Ortopedi ve Travmatoloji, Zonguldak Karaelmas Universitesi Tip Fakültesi, Hastanesi, 67600 Kozlu, Zonguldak, Turkey.
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Bayar U, Basaran M, Atasoy N, Ayoglu H, Sade H, Altunkaya H. Comparison of satisfaction and pain relief between patients-controlled analgesia and interval analgesia after laparoscopic ovarian cystectomy. J Psychosom Obstet Gynaecol 2008; 29:139-45. [PMID: 17943589 DOI: 10.1080/01674820701661112] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Preoperative and postoperative psychological factors, postoperative pain, analgesic consumption, treatment satisfaction were compared in patients treated with intravenous patient-controlled analgesia (IV-PCA) or intramuscular analgesics after laparoscopic ovarian cystectomy. Thirty-one women with laparoscopically operated benign ovarian cysts were recruited in Zonguldak Karaelmas University Faculty of Medicine, Department of Obstetrics and Gynecology. Postoperatively sixteen women received morphine delivered by IV-PCA pump system and 15 women were prescribed another opioid (meperidine) intramuscularly. Two weeks before and one day after the surgery, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were self-administered. Afterwards, the operation visual analog scale (VAS) and satisfaction with pain control scale were recorded. Preoperative BDI and BAI scores of both groups were comparable. Postoperative BDI (7.9 +/- 7.2 versus 13.8 +/- 6.9, P = 0.03) and BAI (11.4 +/- 9.1 versus 17.4 +/- 6.2, P = 0.045) scores were significantly lower in the IV-PCA group. Morphine usage with PCA resulted in significantly higher pain scores than equivalent doses of meperidine administered intramuscularly (2.94 +/- 1.0 versus 1.67 +/- 0.7, P = 0.001). Although higher pain scores were obtained from IV-PCA group, self-reported satisfaction rates were higher in this group (8.3 +/- 1.1 versus 7.4 +/- 1.1, P = 0.04). Involvement of patients in their pain management might increase the awareness of pain but their satisfaction about the control of postoperative pain was significantly improved.
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Affiliation(s)
- Ulkü Bayar
- Department of Obstetrics and Gynecology, Zonguldak Karaelmas University Faculty of Medicine, Zonguldak, Turkey.
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Brander V, Gondek S, Martin E, Stulberg SD. Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 2007; 464:21-6. [PMID: 17603386 DOI: 10.1097/blo.0b013e318126c032] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED We previously reported preoperative depression, anxiety, and pain were associated with greater pain, more utilization of healthcare resources, and worse outcome 1 year after total knee arthroplasty. We asked whether these outcomes persisted over time and whether patients with unexplained heightened pain early after surgery were ultimately satisfied. We prospectively followed and evaluated 83 patients (109 TKAs) 5 years postoperative. The mean age was 66 years; 55% were women. Preoperative pain and depression predicted lower Knee Society score mostly related to lower function subscores. Although anxiety was associated with greater pain, worse function, and more use of resources in the first year after surgery, anxiety did not affect ultimate outcome. Most patients required a full year to recover from surgery but with negligible improvements in most parameters afterward. However, patients with heightened, unexplained pain at 1 year had progressive improvement in pain over several years. By 5 years, nearly all of these patients were satisfied. Therefore, assuming good range of motion and well-aligned implants, most patients with pain 1 year after surgery can be reassured pain ultimately improves. Depression drives long-term outcomes; the Knee Society score is influenced by psychologic variables and does not solely reflect issues related to the knee. Expansion of this tool to include measures sensitive to psychologic and other health factors should be considered. LEVEL OF EVIDENCE Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Victoria Brander
- Northwestern University Feinberg School of Medicine, Northwestern Orthopedic Institute, Chicago, IL 60611, USA.
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Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S, Turunen V, Viinamäki H. Lumbar spinal stenosis patients are satisfied with short-term results of surgery - younger age, symptom severity, disability and depression decrease satisfaction. Disabil Rehabil 2007; 29:537-44. [PMID: 17453974 DOI: 10.1080/09638280600902646] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To study the lumbar spinal stenosis (LSS) patients' (n = 98) satisfaction with surgery outcome and associated factors at three months post-operative stage. METHOD LSS-related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. Depression was assessed with 21-item Beck Depression Inventory. Psychological well-being was assessed with the Life satisfaction scale, Toronto Alexithymia Scale and Sense of Coherence Scale. All questionnaires were administered before and 3 months after surgical treatment of LSS. Satisfaction with surgery outcome was assessed with a separate scale. RESULTS Considerable improvement was evident in all the functional and pain-related variables. Two-thirds (66%) of the patients were at least clearly satisfied with the surgery outcome. Younger age, symptom severity, disability and depression were independently associated with dissatisfaction with surgery outcome. CONCLUSION The lack of physical, functional and emotional well-being is associated with the patients' dissatisfaction with the surgery outcome. Patient satisfaction is a valid outcome to be measured in LSS patients undergoing surgery. It is recommended that patients should be provided with realistic pre-operative patient information and that depression be assessed pre-operatively.
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Affiliation(s)
- Sanna Sinikallio
- Department of Rehabilitation, Kuopio University Hospital, Kupio, Finland.
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Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S, Turunen V, Viinamäki H. Depression is associated with poorer outcome of lumbar spinal stenosis surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:905-12. [PMID: 17394027 PMCID: PMC2219645 DOI: 10.1007/s00586-007-0349-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 02/09/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
The objective of this observational prospective study was to investigate the effect of depression on short-term outcome after lumbar spinal stenosis (LSS) surgery. Surgery was performed on 99 patients with clinically and radiologically defined LSS, representing ordinary LSS patients treated at the secondary care level. They completed questionnaires before surgery and 3 months postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with Oswestry disability index, Stucki Questionnaire, self-reported walking ability, visual analogue scale (VAS) and pain drawing. Preoperatively, 20% of the patients had depression. In logistic regression analyses, significant associations were seen between preoperative depression and postoperative high Oswestry disability and Stucki severity scores and high intensity of pain (VAS score). In subsequent analyses, the patients with continuous depression, measured with BDI (60% of the patients who had preoperative depression), showed fewer improvements in symptom severity, disability score, pain intensity and walking capacity than the patients who did not experience depression at any phase. In those patients who recovered from depression, according to BDI-scores (35% of the patients with preoperative depression), the postoperative improvement was rather similar to the improvement seen in the normal mood group. In the surgical treatment of LSS, we recommend that the clinical practice should include an assessment of depression.
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Affiliation(s)
- Sanna Sinikallio
- Department of Rehabilitation (2981), Kuopio University Hospital, Tarinan sairaala, 71800 Siilinjärvi, Finland.
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Ericsson E, Wadsby M, Hultcrantz E. Pre-surgical child behavior ratings and pain management after two different techniques of tonsil surgery. Int J Pediatr Otorhinolaryngol 2006; 70:1749-58. [PMID: 16814402 DOI: 10.1016/j.ijporl.2006.05.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this investigation was to compare child behavior before surgery with experience of pain and anxiety in relation to two techniques of tonsil surgery, to relate previous experiences of surgery/tonsillitis with anxiety and pain, and to compare the children's, parent's and nurse's rating of pain. METHOD Ninety-two children (5-15 years) with sleep-disordered breathing (SDB) and with or without recurrent tonsillitis were randomized to partial tonsil resection/tonsillotomy (TT) or full tonsillectomy (TE). MEASURES Parents: Child Behavior Checklist (CBCL). Children: State-Trait-Anxiety Inventory for Children (STAIC) and seven-point Faces Pain Scale (FPS). Parents/staff: seven-point Verbal Pain Rating Scale (VPRS). Pain relievers were opoids, paracetamol and diclophenac. RESULTS These children with SDB scored significantly higher on CBCL than did normative groups, but no connection was observed between CBCL rating and experience of pain. There was no relation between pre-operative anxiety and pain. The post-operative anxiety level (STAIC) correlated with pain. The TE-group scored higher on STAIC after surgery. Previous experience of surgery or tonsillitis did not influence post-operative pain. The TE-group rated higher experience of pain despite more medication. The nurses scored pain lower than the parents/children and under-medicated. CONCLUSION SDB may influence children's behavior, but with no relation to post-operative pain. The surgical method predicts pain better than does the child's behavior rating. The nurses underestimated the pain experienced by the child.
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Affiliation(s)
- Elisabeth Ericsson
- Division of Otorhinolaryngology, Department of Neuroscience and Locomotion (INR), Faculty of Health Sciences, University of Linköping, SE-581 85 Linköping, Sweden.
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Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S, Turunen V, Viinamäki H. Depression and associated factors in patients with lumbar spinal stenosis. Disabil Rehabil 2006; 28:415-22. [PMID: 16507504 DOI: 10.1080/09638280500192462] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the prevalence of depression and associated factors in patients (n = 100) with lumbar spinal stenosis selected for surgical treatment. METHOD Depression was assessed with the 21-item Beck Depression Inventory. Psychological well-being was assessed with Life Satisfaction Scale, Toronto Alexithymia Scale and Sense of Coherence Scale. Physical functioning and pain were assessed with the Oswestry disability index, the questionnaire devised by Stucki and the Visual Analogue Scale. All questionnaires were administered before surgical treatment of lumbar spinal stenosis. RESULTS Twenty percent of the patients with LSS were found to have clinically important depression. In univariate analyses, subjective disability measured with the Oswestry disability index, low sense of coherence and poor life satisfaction were common in depressed patients. In the multiple logistic regression analyses, being dissatisfied with life was associated with depression. When sense of coherence score was included in the model, then only low sense of coherence was independently associated with depression. Neither socio-demographic nor pain-related factors associated with depression. CONCLUSIONS Clinically important depression is rather common among preoperative patients with lumbar spinal stenosis. The factors associated with depression are subjective disability of everyday living and decreased life satisfaction. A low sense of coherence is an important correlate of depression. The results underline the importance of assessing depression in clinical practice dealing with these patients.
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Affiliation(s)
- Sanna Sinikallio
- Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland.
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Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg 2006; 14:397-405. [PMID: 16822887 DOI: 10.5435/00124635-200607000-00002] [Citation(s) in RCA: 257] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.
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Affiliation(s)
- Patricia H Rosenberger
- Department of Epidemiology and Public Health, Yale University, School of Medicine, New Haven, CT 06520-80701, USA
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den Boer JJ, Oostendorp RAB, Beems T, Munneke M, Oerlemans M, Evers AWM. A systematic review of bio-psychosocial risk factors for an unfavourable outcome after lumbar disc surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:527-36. [PMID: 15915334 PMCID: PMC3489340 DOI: 10.1007/s00586-005-0910-x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2004] [Revised: 12/22/2004] [Accepted: 02/11/2005] [Indexed: 10/25/2022]
Abstract
The objective of this systematic review is to summarize scientific evidence concerning the predictive value of bio-psychosocial risk factors with regard to the outcome after lumbar disc surgery. Medical and psychological databases were used to locate potentially relevant articles, which resulted in the selection of 11 studies. Each of these studies has a prospective design that examined the predictive value of preoperative variables for the outcome of lumbar disc surgery. Results indicated that socio-demographic, clinical, work-related as well as psychological factors predict lumbar disc surgery outcome. Findings showed relatively consistently that a lower level of education, a higher level of preoperative pain, less work satisfaction, a longer duration of sick leave, higher levels of psychological complaints and more passive avoidance coping function as predictors of an unfavourable outcome in terms of pain, disability, work capacity, or a combination of these outcome measures. The results of this review provide preliminary opportunities to select patients at risk for an unfavourable outcome. However, further systematic and methodologically high quality research is required, particularly for those predictors that can be positively influenced by multidisciplinary interventions.
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Affiliation(s)
- Jasper J den Boer
- Department of Physical Therapy, UMC Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Hammarsten R, Hildingh C. Swedish patients' perceptions of a preoperative skin test. AORN J 2005; 81:531-8, 541-6, 549-52. [PMID: 15799505 DOI: 10.1016/s0001-2092(06)60439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PREOPERATIVE PREPARATION is an important aspect of creating a safe and pleasant hospital experience for surgical patients. Evaluating patient satisfaction, however, also depends on determining patients' perceptions of the care they receive. THIS STUDY used a descriptive, qualitative method with a phenomenographic approach to determine how patients perceived undergoing a preoperative skin test that was developed to ascertain what substances might result in intraoperative reactions in patients with allergies, asthma, or eczema. OVERALL, the patients had positive perceptions of the skin test; however, the results indicate a need for improved and individualized preoperative instruction that focuses on patients from a holistic perspective.
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Cohen L, Fouladi RT, Katz J. Preoperative coping strategies and distress predict postoperative pain and morphine consumption in women undergoing abdominal gynecologic surgery. J Psychosom Res 2005; 58:201-9. [PMID: 15820849 DOI: 10.1016/j.jpsychores.2004.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2003] [Accepted: 07/20/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of the present study was to predict postoperative pain and morphine consumption based on preoperative psychosocial factors. METHODS One hundred and twenty-two women completed measures of distress and coping 1 week before major abdominal gynecological surgery by laparotomy. Forty-eight hours after surgery, measures of pain and negative affect (NA) were completed, and morphine consumption was recorded from a patient-controlled analgesia pump. Four weeks after surgery, measures of pain and NA were completed. RESULTS Multivariate analyses revealed that preoperative self-distraction coping (P=.039) positively predicted postoperative pain levels in the hospital, after accounting for the effects of age, concurrent NA, and morphine consumption. Emotional support (P=.031) and religious-based coping (P=.036) positively predicted morphine consumption in the hospital, after accounting for the effects of age, concurrent NA, and pain levels. Preoperative distress (P<.04 to .008) and behavioral disengagement (P=.034), emotional support (P=.049), and religious-based coping (P=.001) positively predicted pain levels 4 weeks after surgery, after accounting for the effects of age and concurrent NA. CONCLUSION The results suggest that preoperative psychosocial factors are associated with postoperative pain and morphine consumption.
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Affiliation(s)
- Lorenzo Cohen
- Department of Behavioral Science, The University of Texas, M.D. Anderson Cancer Center, Box 243, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Montgomery GH, Bovbjerg DH. Presurgery distress and specific response expectancies predict postsurgery outcomes in surgery patients confronting breast cancer. Health Psychol 2004; 23:381-7. [PMID: 15264974 DOI: 10.1037/0278-6133.23.4.381] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prior to scheduled surgery, patients frequently experience particularly high levels of distress and expect a variety of postsurgery symptoms. Surgery patients who confront breast cancer are no exception. It has been suggested that such presurgery distress and response expectancies are predictive of postsurgery outcomes. To test the contribution of presurgery distress and expectancies to common postsurgery symptom outcomes (pain, nausea, fatigue, and discomfort), 63 female patients undergoing breast cancer surgery were recruited to a prospective study. Results indicated that presurgery distress uniquely contributed to patients' postsurgery nausea, fatigue, and discomfort; specific expectancies uniquely contributed to pain intensity, pain unpleasantness, and fatigue (ps < .05). Consistent with expectancy theory, associations between response expectancies and postsurgery outcomes were not due to presurgery distress.
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Affiliation(s)
- Guy H Montgomery
- Integrative Behavioral Medicine Program and Biobehavioral Medicine Program, Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Rosenberger PH, Ickovics JR, Epel ES, D’Entremont D, Jokl P. Physical recovery in Arthroscopic knee surgery: unique contributions of coping behaviors to clinical outcomes and stress reactivity. Psychol Health 2004. [DOI: 10.1080/0887044042000193460] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
OBJECTIVE Emergency surgery is a highly stressful life event. Patients experience distressing anxiety both before and after surgery and this anxiety affects their recovery process. The aim of the present study is to examine variables related to pre- and postoperative anxiety in emergency surgery patients. METHODS The sample consisted of 146 emergency surgery patients who had abdominal surgery in an emergency surgery clinic. The research instruments were administered before and after the surgery. State Anxiety Inventory (STAI-A State), Anxiety Specific to Surgery Questionnaire (ASSQ), a scale tapping fears and worries specific to surgery developed for the present study, Ways of Coping Inventory (WCI), and the Multidimensional Scale of Perceived Social Support (MSPSS) were administered. DATA ANALYSIS Data were analyzed by using the appropriate programs of the Statistical Package for the Social Sciences (SPSS). RESULTS There was a significant drop in anxiety from the pre- to the postoperative period. Female patients had higher preoperation anxiety than males. Females and males did not differ in anxiety at the postoperation period. Being female, waiting for primary suture for peptic ulcer perforation operation, and helplessness and self-blaming coping appeared as significant predictors of anxiety specific to surgery. Being female and awaiting for primary suture for peptic ulcer perforation were significant predictors of preoperative state anxiety. Finally, years of education were negatively and use of active coping was positively related to postoperative state anxiety. CONCLUSION Patient sociodemographic and psychological characteristics and type of surgery need to be considered for identifying patients at risk of experiencing anxiety both before and after surgery and psychological support and clinical management needs to be tailored to the needs of the patients to alleviate their anxiety.
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Affiliation(s)
- A N Karanci
- Department of Psychology, Middle East Technical University, 06531 Ankara, Turkey.
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Edwards R, Augustson E, Fillingim R. Differential relationships between anxiety and treatment-associated pain reduction among male and female chronic pain patients. Clin J Pain 2003; 19:208-16. [PMID: 12840614 DOI: 10.1097/00002508-200307000-00003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Clinical, epidemiological, and laboratory-based studies have all suggested that female sex and elevated anxiety are associated with greater experience of pain. However, several recent reports have also indicated that sex may moderate the relationship between anxiety and responses to noxious stimuli, with anxiety more strongly related to pain among males. The present study examined whether anxiety differentially impacts outcomes for pain treatment among males and females. METHODS Seventy-four chronic pain patients (34 males, 40 females) completed the Pain Anxiety Symptoms Scale and several other psychologic measures before undergoing a variety of treatment procedures including epidural steroids, trigger point injections, and participation in brief, cognitive-behaviorally oriented psychoeducational groups. Patients provided pre- and post-treatment ratings of pain for all interventions. RESULTS Consistent with findings from previous investigations, the present study noted stronger relationships between baseline anxiety and pre-treatment pain severity among males relative to females. In addition, while lower levels of baseline anxiety were related to greater treatment-associated pain reduction among females, the reverse pattern emerged for males. These relationships persisted even after controlling for other psychologic factors such as depression, coping style, and hypervigilance. DISCUSSION These findings suggest differential relationships between anxiety and pain relief as a function of sex. While we are unable to identify a mechanism for this effect, higher anxiety may have predicted more pain relief among males and less pain relief among females due to sex differences in coping strategies or placebo effects.
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Affiliation(s)
- Robert Edwards
- Department of Psychology, Rush-Presbyterian-St. Luke's Medical Center, Rush University, Chicago, Illinois 60612-3833, USA
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Abstract
OBJECTIVE To critically evaluate the interpretation of the findings reported in the peer-reviewed literature concerning the association of state and trait anxiety with surgical recovery and response to surgery. METHODS The Social Science Citation Index (SSCI), Science Citation Index (SCI), Medline and Psychological Abstracts (PsycInfo) databases were searched for studies published since 1981. Reference lists from previous reviews were also searched for additional references. Studies that were not in the public domain were not searched for. RESULTS Twenty-seven studies were identified by the search strategy, met the inclusion criteria and contributed to the review. CONCLUSIONS Associations between preoperative measures of anxiety and postoperative mood and pain have been consistently reported. Associations with regard to other recovery variables are less consistent. The existing evidence does not rule out an interpretation of the results as reflecting consistent self-reporting bias rather than causal association.
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Affiliation(s)
- M R Munafò
- University of Southampton, Southampton, UK.
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Salmon P, Hall GM, Peerbhoy D. Influence of the emotional response to surgery on functional recovery during 6 months after hip arthroplasty. J Behav Med 2001; 24:489-502. [PMID: 11702361 DOI: 10.1023/a:1012275611394] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We examined whether the emotional response to hip arthroplasty predicted functional recovery after controlling for preoperative function and surgical trauma. Mood and fatigue were measured in 102 consecutive patients preoperatively and 3 days postoperatively. Time of achievement of functional milestones indicated recovery in hospital, and functional status was measured preoperatively and 1 and 6 months postoperatively. Circulating C-reactive protein and interleukin-6 levels indicated trauma. Recovery in hospital was slower in patients with greater trauma. Recovery at follow-up was slower in patients with poorer preoperative function and with greater anxiety and fatigue, but the apparent influence of anxiety was explained by its association with preoperative function and fatigue. Whereas short-term recovery is predicted by surgical trauma, long-term recovery is predicted by preexisting function and the emotional response to surgery. However, the influence of the emotional response is small and the important aspect of emotion is fatigue rather than anxiety.
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Affiliation(s)
- P Salmon
- Department of Clinical Psychology, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool L69 3GB, U.K.
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De Bruin JT, Schaefer MK, Krohne HW, Dreyer A. Preoperative anxiety, coping, and intraoperative adjustment: Are there mediating effects of stress-induced analgesia? Psychol Health 2001. [DOI: 10.1080/08870440108405505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Losiak W. Can patterns of coping explain more? a study of coping and emotions in surgical stress. ANXIETY STRESS AND COPING 2001. [DOI: 10.1080/10615800108248355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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