Oral Posters: Values and Outcomes in Spine Surgery

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

Author(s):

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

Abstract

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.