Anxiety and depression in spine surgery—a systematic integrative review

Strøm, Janni; Bjerrum, Merete; Nielsen, Claus Vinther; Thisted, Cecilie Nørby; Nielsen, Tove Lise; Laursen, Malene; Jørgensen, Lene Bastrup

doi:10.1016/j.spinee.2018.03.017

Cited by 133 publications

(114 citation statements)

References 63 publications

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“…29 Moreover, an integrative review by Strøm et al highlighted the prevalence and challenges faced by providers and surgeons in treating spine surgery patients with anxiety and depression. 39 Smoking status has also been shown to adversely affect outcomes. Crawford et al, in their analysis of 7207 patients undergoing lumbar spine surgery, found that smokers were less likely to be satisfied than nonsmokers.…”

Section: Discussionmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the “value”-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1–4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5–9] vs 8 [6–9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09–2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27–3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30–4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

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Section: Discussionmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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“…The perception of pain in relation to spinal surgery can be altered by external factors, and psychosocial characteristics related to different degrees of clinical impairment and quality of life in the preoperative period may influence surgical recovery [5]. For example, patients with chronic and disabling symptoms may experience symptoms of anxiety and depression, which are important outcome predictors of physical impairment, pain and lower health-related quality of life [6,7,8]. Factors associated with anxiety and depression both before and after spine surgery are reported to be a greater experience of pain, the need for information, the degree of self-reported disability, employment status (feelings of not being able to contribute to society) and mental health status [8].…”

Section: Introductionmentioning

confidence: 99%

“…For example, patients with chronic and disabling symptoms may experience symptoms of anxiety and depression, which are important outcome predictors of physical impairment, pain and lower health-related quality of life [6,7,8]. Factors associated with anxiety and depression both before and after spine surgery are reported to be a greater experience of pain, the need for information, the degree of self-reported disability, employment status (feelings of not being able to contribute to society) and mental health status [8]. The need for information is reported to be a significant theme amongst qualitative studies from spinal surgery, with patients expressing a need for individualized information given in sufficient quantities and at the appropriate time [8].…”

Section: Introductionmentioning

confidence: 99%

“…It has been described as providing patients with health-related information, teaching them skills aimed at reducing discomfort and complications and offering psychological support [10]. As perception can be altered by external factors [5], providing patients with pertinent information may help to attenuate preoperative anxiety by inducing feelings of control [8]. There is evidence to suggest that those who gain sufficient knowledge can improve their coping ability and subsequently engage in appropriate attitudes and behaviors [11].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review

2019

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Psychosocial factors related to different degrees of clinical impairment and quality of life in the preoperative period may influence outcomes from elective spine surgery. Patients have expressed a need for individualized information given in sufficient quantities and at the appropriate time. Therefore, this review article aims to determine whether a preoperative education session improves clinical, psychological and economic outcomes in elective spinal surgery. PubMed, Cochrane Library, CINAHL Complete, Medline Complete and PsychINFO were searched in July 2018 for randomized clinical trials to evaluate the effects of a preoperative education intervention on psychological, clinical and economic outcomes in spinal surgery. The search yielded 78 results, of which eleven papers (seven studies) were relevant for inclusion. From these results, there is limited, fair-quality evidence that supports the inclusion of a preoperative education session for improving clinical (pain, function and disability), economic (quality-adjusted life years, healthcare expenditure, direct and indirect costs) and psychological outcomes (anxiety, depression and fear-avoidance beliefs) from spinal surgery. Other benefits are reported to be improved patient knowledge, feelings of better preparation, reduced negative thinking and increased levels of physical activity after the intervention. No differences in quality of life, return to work, physical indicators or postoperative complications were reported. From the limited evidence, it is not possible to conclusively recommend that preoperative education should be delivered as a standalone intervention before elective spine surgery; however, given the low risk profile and promising benefits, future research in this area is warranted.

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“…Poor outcome appears to be associated with a number of complex elements, including psychological responses such as fear and anxiety (8). Evidence suggests that many patients undergoing lumbar spine surgery may suffer from central sensitization, depression, anxiety, and poor coping strategies (9,10).…”

Section: Introductionmentioning

confidence: 99%

Patient Information Leaflets for Lumbar Spine Surgery: A Missed Opportunity

Low

Burgess

Wainwright

2019

Journal of Patient Experience

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Background: High-quality patient information is recommended to help reduce procedure-related anxiety and encourage patients to become active participants in their recovery. The objective of this study was to analyze the quality of patient information leaflets (PILs) given to National Health Service (NHS) patients ahead of lumbar spine surgery. Methods: The DISCERN tool was used to evaluate the quality of PILs, sourced from NHS websites. Results: Thirty-two PILs on lumbar surgery were included. Two (6%) leaflets were considered poor, 13 (41%) were marked as fair, 14 (44%) were of good quality, and 3 (9%) were scored as excellent. The total mean score was 55 (30-74), which corresponds to good quality. The lowest scoring questions were sources of information (Q4), balanced/unbiased content (Q6), and explanation of no treatment (Q12). Conclusions: There is considerable variation in the quality of PILs provided ahead of lumbar spine surgery. The scope for improvement is clear, and as the move toward patient-centered, evidence-based care continues, it is important that hospital resources provide recommendations based upon evidence of clinical effectiveness.

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Anxiety and depression in spine surgery—a systematic integrative review

Abstract: 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.

Cited by 133 publications

References 63 publications

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

The Effect of Preoperative Education on Psychological, Clinical and Economic Outcomes in Elective Spinal Surgery: A Systematic Review

Patient Information Leaflets for Lumbar Spine Surgery: A Missed Opportunity

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