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: 2.4). 08/2006; 14(7):397-405.
Source: PubMed

ABSTRACT 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.
    03/2014; 12(1):21–24. DOI:10.1016/j.aju.2013.06.005
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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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    ABSTRACT: Understanding chronic pain requires an understanding of psychological factors related to the pain experience. This paradigm is the standard foundation for pain medicine as well as physical medicine and rehabilitation diagnosis and treatment. Pain patients with spine disease frequently present with a multifaceted array of physical and psychological aspects including depression, anxiety, traumatic stress, cognitive dysfunction, a potential for substance abuse, and regressed social functioning. An evolving standard of care mandates that prior to invasive pain therapies for spinal pain psychological suitability be determined. Spine pain disorders in the context of ongoing litigation present complex clinical situations which cannot be managed by medical treatments alone. The litigation will add stress and disruption to the medical diagnosis and treatment. The biopsychosocial model with inclusion of clinical psychologists as members of the treatment team is essential. This review will consider the important factors essential for a best practice approach to management of the spine pain patient with coexisting litigation.
    06/2013; 1(2). DOI:10.1007/s40141-013-0015-0
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