Catley Caellagh D, Romans Sarah C, Cheng Abby L, Calfee Ryan P
Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
J Hand Surg Am. 2024 Dec;49(12):1212-1218. doi: 10.1016/j.jhsa.2024.08.005. Epub 2024 Sep 21.
To determine whether patients presenting with Patient-Reported Outcome Measurement Information System (PROMIS) anxiety scores at >95th percentile of the US population undergo elective hand surgery at rates different from patients with less anxiety. Secondarily, we aimed to assess surgeon notation of these patients' emotional states and incidences of postoperative complications.
This single-center retrospective cohort study analyzed data from new adult patients presenting for hand care between January 2019 and December 2020. Patients with initial PROMIS anxiety scores ≥70 were identified as the high anxiety burden (HAB) group. For each patient with HAB presenting with carpal tunnel syndrome, trigger finger, and distal radius fractures (n = 45), three controls were matched (n = 135). After matching, bivariate statistical analysis compared outcome variables of interest between patient groups. Sentiment analysis was used to explore if patient anxiety was realized and considered in surgical decision making.
After matching, patients with HAB averaged baseline PROMIS scores in every assessed domain that were ≥1 SD worse than unaffected patients. Patients with HAB and control patients were offered surgery at a comparable rate (58% vs 47%). Among those offered surgery, patients with HAB were less likely to undergo surgery (73% vs 92%). Postoperative complications occurred more frequently in the patients with HAB (32% vs 8%). Sentiment analysis of office notes revealed that the patients with HAB had their emotional state explicitly noted more often (40% vs 24%), but the majority of patients with HAB did not have this addressed in records.
Patients with HAB both underwent surgery offered less frequently and when undergoing surgery, experienced more complications. Surgeons are likely to miss opportunities to positively influence extreme patient anxiety as most patients with HAB were treated without mention of their emotional state. Future investigations should explore whether preoperative anxiety alleviation could diminish these disparities.
TYPE OF STUDY/LEVEL OF EVIDENCE: Symptom Prevalence III.
确定患者报告结局测量信息系统（PROMIS）焦虑评分处于美国人群第95百分位数以上的患者接受择期手部手术的比率是否与焦虑程度较低的患者不同。其次，我们旨在评估外科医生对这些患者情绪状态的记录以及术后并发症的发生率。
这项单中心回顾性队列研究分析了2019年1月至2020年12月期间前来接受手部护理的成年新患者的数据。初始PROMIS焦虑评分≥70的患者被确定为高焦虑负担（HAB）组。对于每例患有腕管综合征、扳机指和桡骨远端骨折的HAB患者（n = 45），匹配三名对照患者（n = 135）。匹配后，采用双变量统计分析比较患者组之间的感兴趣结局变量。使用情感分析来探讨患者的焦虑在手术决策中是否得到认识和考虑。
匹配后，HAB患者在每个评估领域的平均基线PROMIS评分比未受影响的患者差≥1个标准差。HAB患者和对照患者接受手术的比率相当（58%对47%）。在那些被建议手术的患者中，HAB患者接受手术的可能性较小（73%对92%）。HAB患者术后并发症的发生率更高（32%对8%）。对门诊记录的情感分析显示，HAB患者的情绪状态被明确记录的频率更高（40%对24%），但大多数HAB患者的这一情况在记录中未得到处理。
HAB患者接受手术的频率较低，并且在接受手术时，经历的并发症更多。由于大多数HAB患者在治疗时未提及他们的情绪状态，外科医生可能会错过积极影响患者极度焦虑的机会。未来的研究应探讨术前焦虑缓解是否可以减少这些差异。
研究类型/证据水平：症状患病率III级。
