Psychosocial factors and surgical outcomes: An evidence-based literature review

Department of Epidemiology and Public Health, Yale University, School of Medicine, New Haven, CT 06520-80701, USA.
The Journal of the American Academy of Orthopaedic Surgeons (Impact Factor: 2.53). 08/2006; 14(7):397-405.
Source: PubMed


The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

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    • "Extensive research has shown the effectiveness of integrative medical strategies to improve the outcomes of surgery. As one example, a lower level of stress and anxiety is associated with improved outcomes of surgery , including fewer complications and a faster recovery [13]. Some 'mind–body' techniques have been shown to decrease stress and anxiety, reduce pain, lessen the amounts of medication required, and even reduce blood loss during surgery, all of which might result in a shorter hospital stay [14]. "
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    ABSTRACT: Introduction The holistic approach in medicine is a framework that considers and treats all aspects of a patient’s needs, as it relates to their health. The goal of such an approach is to prevent illness, and to maximise the well-being of individuals and families. Holistic medicine is also referred to as integrative, which has been interpreted by some professionals as the combination of evidence-based medicine and complementary medicine. The problem The speciality of Family Medicine (FM) is often referred to as General Practice (GP), a terminology which emphasises the holistic nature of that discipline. Furthermore, GP/FM professional bodies in some countries have incorporated the holistic and integrative approach into curricula and guidelines for doctors in training, which reflects its acceptance as a component of medical training. However, despite this validation, and despite research showing the effectiveness of such strategies in enhancing the outcomes of surgery, a holistic framework or integrative approach has not been equally integrated into speciality training for would-be surgeons. Conclusion We argue that it would be advisable to include holistic approaches into surgical training and help surgeons to recognise their role in the continuum of care.
    Arab Journal of Urology 03/2014; 12(1):21–24. DOI:10.1016/j.aju.2013.06.005
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    • "A recent study has reported psychological variables (e.g., mood, cognition, and coping strategies) as contributing factors when explaining such variance in functional independence.7 A further study found a relationship among mood, coping style, and functional outcome, while positive coping and getting on with life were significantly related to functional outcome in 228 of the patient participants.22 "
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    ABSTRACT: To evaluate the severity of depression, degree of life satisfaction, level of stress, and resilience among patients in the first 6 months after a spinal cord injury (SCI). 36 patients with SCI were asked to fill out questionnaires concerning Beck Depression Inventory (BDI), World Health Organization Quality of Life Questionnaire-BREF, Stress Response Inventory, and Connor-Davidson resilience scale. All patients had experienced an SCI within the last 6 months before the commencement of this study. In our study, the patients who experienced the SCI within the last six months had a higher rate of depression (63.9%) and a higher overall level of depression (13.8 points). The unmarried group had a significantly higher quality of life (QOL; p<0.05) when compared with the married group. In the motor complete group, severity of depression and level of stress were higher, whereas QOL was lower than the motor incomplete group (p<0.05). The mean American Spinal Injury Association (ASIA) Motor Score (AMS) was much higher in the non-depressive group (p<0.05) when compared with the depressive group. We found the patients within six months after SCI injury had higher rate of depression and higher overall level of depression. Also, patients with motor complete injury had affected significantly on depression, QOL and stress. We found the married patients had poorer QOL and depressive group had lower AMS score of lower extremity. Therefore, there should be emphasis of psychological care who have motor complete injury and are married during the early stage.
    Annals of Rehabilitation Medicine 02/2012; 36(1):119-25. DOI:10.5535/arm.2012.36.1.119
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    ABSTRACT: Zusammenfassung: Der vorliegende Überblicks- artikel soll die bisherigen Ergebnisse zur Rolle psychologischer Variablen für den postoperativen Schmerzverlauf zusammenfassen. Prädiktoren - forschung ist in diesem Kontext besonders wichtig, um Erklärungsmodelle des postoperativen Schmerz - verlaufs zu validieren und um die Methoden der Schmerzbehandlung und der Prophylaxe zu optimie- ren. Rein somatische Vorhersagemodelle haben sich als nicht ausreichend herausgestellt, um die Varianz des akuten, persistierenden und chronischen post- operativen Schmerzerlebens befriedigend aufklären zu können. Es müssen gleichermaßen psychologi- sche Variablen berücksichtigt werden. Deren ent- scheidende Bedeutung für die Vorhersage postope- rativer Schmerzen hat sich mittlerweile in zahlreichen Untersuchungen herauskristallisiert, wenn auch mit teils heterogenen Ergebnissen bezüglich einzelner Prädiktoren. Im Rahmen der vorliegenden Arbeit werden die zwischen 1996 und 2007 veröffentlichten Studien zusammengefasst. Es wurden 50 Studien, in denen der Zusammenhang zwischen psychologi- schen Variablen und dem akuten, persistierenden und chronischen Schmerzverlauf nach operativen Eingriffen untersucht wurde, ausgewertet und bezüg- lich der methodischen Qualität eingestuft. Die Auswertung wurde jeweils getrennt für den akuten, persistierenden und chronischen postoperativen Schmerzverlauf vorgenommen. Die meisten For - schungsergebnisse liegen im Bereich des postopera- tiven Akutschmerzes vor. Es ergeben sich deutliche Hinweise, dass spezifische Erwartungen bezüglich Schmerz und Operation, spezifische Angst, Zu - stands angst, der Persönlichkeitsfaktor Neurotizis - mus sowie bestimmte Parameter der Schmerz - sensibilität in signifikantem Zusammenhang mit dem postoperativen Akutschmerzverlauf stehen. Depres - sion scheint ein Prädiktor für chronische postopera- tive Schmerzen zu sein. Schlüsselwörter: Schmerz, postoperativer - Psychologische Variablen - Vorhersage. Summary: This review aims at summarizing the existing research on the role that psychological variables play in the course of postoperative pain. The quest for predictors is especially relevant in order to validate explanatory models of postopera - tive pain and to optimize methods of pain treatment and prevention. It has been shown that mere so matic models of prediction are not sufficient to explain the variance of acute, persistent and chronic postopera- tive pain. Psychological variables must be taken into consideration as well. Their critical relevance concern ing the prediction of postoperative pain has already been shown in many studies, though with heterogeneous results for certain predictive vari - ables. This review summarizes the studies published between 1996 and 2007. Fifty studies which assess - ed the correlations between psychological variables and acute, persistent or chronic postoperative pain were evaluated and rank-ordered according to their methodological quality. The evaluation was conduct - ed separately for acute, persistent and chronic post- operative pain. Most research has been conducted on acute postoperative pain. There is substantial evidence that specific expectations regarding pain and surgery, specific anxiety, state anxiety, the per- sonality trait neuroticism as well as certain parame- ters of pain sensitivity correlate significantly with acute postoperative pain. Depression seems to be a predictor for chronic postoperative pain.
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