1 Department of Orthopedic Surgery, Washington University in St. Louis, St Louis, MO, USA.
Foot Ankle Int. 2019 Sep;40(9):1007-1011. doi: 10.1177/1071100719850806. Epub 2019 Jun 5.
Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels.
Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety.
Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, < .001) and lower physical function (PROMIS PF: 37.9 vs 42.0, = .001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, < .001; PROMIS PF: 39.8 vs 44.4, < .001; respectively).
Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary.
Level III, retrospective comparative study.
术前情绪困扰已被证明会对关节置换和脊柱手术产生负面影响，但有关足部和踝关节结果的相关数据有限。情绪困扰可以通过现代工具如患者报告结局工具测量系统（PROMIS）焦虑量表来捕捉。我们假设，术前 PROMIS 焦虑评分较高的患者在足部和踝关节手术后会报告更多的疼痛和更少的功能，而术前焦虑水平较低的患者则不会。
回顾性确定了 2016 年 5 月至 2017 年 12 月的择期足部和踝关节手术。在手术前后收集了 PROMIS 焦虑、疼痛干扰（PI）和身体功能（PF）评分。根据术前 PROMIS 评分大于或小于 59.4 将患者分为两组。选择 PROMIS 焦虑评分高于 59.4 作为对应于传统焦虑测量的阈值。
与术前焦虑程度较低的患者（平均：47.2，n=146）相比，术前焦虑程度较高的患者（平均：63.9，n=59）术前疼痛更严重（PROMIS PI：63.5 vs 59.1， <.001），身体功能更差（PROMIS PF：37.9 vs 42.0， =.001）。与术前情绪困扰较轻的患者相比，术前焦虑程度较高的患者术后疼痛残留更多，功能障碍更大（PROMIS PI：58.6 vs 52.9， <.001；PROMIS PF：39.8 vs 44.4， <.001）。
我们的证据表明，术前情绪焦虑预测了早期手术随访时更严重的疼痛和功能。术前焦虑的测量可能有助于识别手术结局较差的患者，但需要进一步研究。
三级，回顾性比较研究。
