Mental health issues may play a role in disabling back pain that can require surgery, and experts recommend mental health screening before spinal surgery. But it seems some surgeons may have missed this recommendation.
The US Preventive Services Task Force (USPSTF) recommends that spine surgeons screen all patients prior to operating. However, few surgeons did such screening in a recently released study.
Depression and anxiety may factor into how well a patient recovers from surgery, the researchers reported.
The recommendations are there for a few reasons, including that they help predict outcomes, according to the authors of this study, led by Richard Skolasky, ScD, of The John Hopkins University in Baltimore. Psychological factors and mental health can impact the success of the surgery, they noted. The screening also allows surgeons to develop a customized treatment plan for after the surgery takes place.
The authors sent out surveys to see how many spine surgeons conducted pre-surgical psychological screening (PSS). It is a 20-25 minute questionnaire. If any concerns are raised by the answers, the surgeons are urged to have the patient follow-up with a psychologist before surgery.
The surveys were sent out to 340 licensed spinal surgeons across the country from December 2010 to January of 2011. The study authors received 110 responses.
Of those who answered, almost half had more than 15 years of experience in their field. Just over half of respondents were based at university hospitals. Most surgeons reported having integrated rehabilitation services, but most respondents also indicated that they did not have an on-staff rehabilitation psychologist.
Only 41 of the orthopedic surgeons and neurosurgeons who answered the questionnaire followed the guidelines and referred patients for screening, the researchers learned, and they did not refer patients consistently. These surgeons routinely screened all patients for depression, but only 35 (85 percent) routinely assessed patients for anxiety. They were most likely to refer patients for PPS if the patient had a psychological disorder, the researchers found.
Dr. Skolasky and colleagues also learned that experienced surgeons were more likely to use the PPS tool than those with less than 15 years of experience as surgeons, and those in private practice or community hospitals were more likely to use the PPS than surgeons in university-affiliated hospitals.
The authors speculated that surgeons may consider psychological screening an unnecessary delay in getting the surgery done, or may not be aware of the role of mental health in recovery.
"Even if patients suffer from anxiety and/or depression, there is not much you can do acutely for them," said Janak A. Parikh, MD, MSHS, of St. John Povidence Health System. "As a GI surgeon, often times medications to treat anxiety and/or depression are not able to be given post-op, and they often need to be started for several weeks to be effective."
“We cannot explain the reasons why surgeons who have more recently finished their residencies and entered practice are less likely to use PPS than more experienced surgeons,” the authors wrote, "but it is anticipated that such demographics will engender future studies that will provide further insight and more detail on factors that may prevent, discourage, or encourage the use of PPS in spine surgeons’ practices.”
This study appeared in the April issue of the Journal of Spinal Disorders and Techniques.
No conflicts of interest were reported.