Abstract
Objectives
To identify associations between demographic characteristics, anxiety, depression, social support, psychological and physical health in relation to self reported disability following elective spine surgery.
Methods
Study design: Prospective cohort study. Patients were asked preoperatively to complete a series of questionnaires, including the Oswestry Disability Index (ODI), the anxiety sensitivity index (ASI-3), the SF-36, the visual analogue scale for pain (VAS), the Berliner Social Support Scale, the PTSS-10 for PTSD symptoms and indicate demographic variables concerning education or partnership for example. The evaluation was based on the ODI filled out 3 months postoperatively. The univariate and multivariate analysis between risk factors and outcome parameter (ODI) was assessed with correlation coefficients and multivariate logistic regression.
Results
144 patients met all inclusion criteria, 54% were male, 46% were female. Regardless of the operation dimension 75% had a lower ODI score at 3 months postoperatively compared with preoperatively and hence had a higher functionality after the operation. Preoperatively high values in age (r=0,153; p = 0,087), pain (VAS) (r=0,287; p = 0,01), trait anxiety(r=0,197; p = 0,027), PTSS (r=0,163; p = 0,069), ODI (r=0,459; p < 0,001) and low levels of social support (BSSS) (r = −0,148; p = 0,099) and education (r = −0,156; p = 0,098) correlated with high levels of ODI postoperatively which identifies all the mentioned variables as potential risk factors. A stepwise logistic regression model showed significant association with age, pain (VAS), state anxiety (STAI-S), and depression symptoms (ADS-K) (p < 0,000).
Conclusion
Preoperative psychological status is associated with worse clinical outcome following elective spine surgery. A screening instrument allowing the identification of such patients is feasible.