Most Surgeons Skip Routine Pre-op Psychological Screenings

Surgical Rounds®April 2014

Survey results show that surgeons still have a long way to go in recognizing how psychological factors can impact the success of back surgeries.

Since 2002, the United States Preventive Services Task Force (USPSTF) has recommended preoperative psychological screening (PPS) for patients undergoing back surgery. The PPS starts with a 20- to 25-minute patient questionnaire and promotes follow-up with a longer assessment by a trained psychologist as needed.

To determine how many surgeons actually comply with this recommendation, researchers at Johns Hopkins University conducted a survey, the results of which appeared in the April 2014 issue of the Journal of Spinal Disorders & Techniques.

The researchers invited 340 spine surgeons to complete an online survey, which was open between December 2010 and January 2011. In addition to basic demographic questions about the surgeons and their practices, the survey asked about the surgeon’s beliefs regarding the impact of psychological conditions on health and recovery, and use of the PPS.

Among the 110 respondents, 41 (37%) used PPS to screen for depression (100%) or anxiety (85%). More experienced surgeons (>15 years of practice), those with higher annual procedural volume (>200 back surgeries annually), and those who practiced independent of a university were more likely to administer PPS. Most spine surgeons did not use PPS routinely, despite indicating they were aware that psychological factors have serious repercussions on patients’ physical health and recovery. Most of the surgeons also said they did not employ an on-staff rehabilitation psychologist. Additionally, only 11 of 103 respondents routinely referred patients for PPS.

Thus, the survey reported only 10% of orthopedic surgeons and neurosurgeons follow professional guidelines recommending routine psychological screenings prior to major surgery for severe back and leg pain, even though more than 600,000 of those surgeries are performed in the US annually. The researchers pointed out that psychological conditions, especially anxiety and depression, can contribute to disabling back pain and poor health outcomes, including longer recuperation, delayed return to work, postsurgical complications, and post-discharge medication noncompliance.

“Our survey results show that surgeons and patients still have a long way to go in recognizing and appreciating how much psychological factors and mental health can impact the success of their back surgeries,” health services researcher and senior study investigator Richard Skolasky, ScD, said. “It may be necessary to delay surgery in order to first treat a patient’s depression or anxiety to minimize the likelihood of prolonged recuperation after their operation.”

The researchers were surprised that spine surgeons in private practices or community hospitals were more likely to administer psychological screening tests than their university-affiliated counterparts.

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