Oral Posters: Values and Outcomes in Spine Surgery

Presented by: S. Brice - View Audio/Video Presentation (Members Only)


X. Hu(1), A. Block(2), S. Brice(1), S. Bederman(1), I. Lieberman(1)

(1) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States


Introduction: Although spine surgeries have been shown to improve pain, physical function and disability in the majority of patients, up to 40% of the patients may not experience significant clinical improvement and up to 23% of the patients may need reoperations. These inconsistencies in outcomes have led health care providers to optimize peri-operative factors that may be associated with an unfavorable outcome. The purpose of this study is to prospectively evaluate the effect of a comprehensive pre-surgical education program on patients' anxiety levels and its potential impact on patients' clinical outcome.

Methods: Adult patients who were scheduled to have spine surgery with two surgeons were consented and prospectively enrolled in the study. Before the pre-surgical education program, the State-Trait Anxiety Inventory (STAI) was used to assess the patients' current (state) and past (trait) anxiety states (higher score = more anxiety, scale 0-80). The CES-D depression scale was used to assess the patients' depression state (higher score = more depression, scale 0-60). The STAI Y1 questionnaire was administrated again to the patients after the pre-surgical education program. The pre-surgical education program consists of a 30 minute education video, a 30 minute 1:1 education with the physician assistant, and a 30 minute tour of the hospital which includes meeting hospital staff on the floor (nurses, physical therapist, etc.).

Results: A total of 81 patients were enrolled in the study. The patients' mean age was 58 years (range 19-83). Fifty three patients (65.4%) were female. Before the pre-surgical education program, the mean score for current (state) and past (trait) anxiety were 38.2±11.8 and 33.8±10.2, respectively. Twenty six patients (32.1%) had significant current anxiety and 12 patients (14.8%) had significant past anxiety (STAI scores 44 points and above). The mean depression score was 12.0 ±10.3 and 21 patients (25.9%) were depressed (CES-D scores 16 points and above). After the pre-surgical education program, on average, the patients' current anxiety level decreased 8.4 (range 0-33) points (p=0.02).

Conclusion: Our data shows that anxiety and depression are present in a significant percentage of patients undergoing spine surgeries. A comprehensive pre-surgical education program can significantly decrease the patients' anxiety levels. Further studies are underway to fully evaluate the effect of optimizing these pre-operative psychological factors on the patients' clinical outcome.