The Need for Preop Psych Evals in Orthopaedic Surgery
OrthoBuzz occasionally receives posts from guest bloggers. This guest post comes from Impact Science, in response to a recent ”What’s Important” article in JBJS.
In orthopaedic surgery, pre-existing psychiatric conditions in patients can have a detrimental effect on outcomes. Previous studies have shown poor improvement in postoperative self-reported pain scores among patients with psychosomatic conditions or mood disorders. Robust published evidence also suggests that psychiatric conditions can lead to complications in the treatment course, including an increased length of hospital stay and higher total systemwide costs. However, despite compelling evidence in the literature, orthopaedic surgeons—especially those early in their career—lack protocols to evaluate a patient’s current and past psychiatric history and symptom severity.
A recent “What’s Important” article in The Journal of Bone & Joint Surgery emphasizes the need for such an assessment tool. In the article, Albert T. Anastasio, MD, a resident in orthopaedic surgery at Duke University Medical Center, cites the example of bariatric surgery, where protocols have long existed for preoperative patient assessments for a history of alcohol and drug abuse. He argues convincingly that the development and use of such tools should be extended to orthopaedic procedures. For example, Dr. Anastasio questions the wisdom of a hypothetical elective spine surgery in a patient with an unaddressed psychosomatic disorder and borderline pathology on advanced imaging.
At the same time, Dr. Anastasio is quick to highlight the challenges of developing such a tool, mainly because of the subjective nature of psychiatric symptoms. But he cites existing tools that attempt to objectively evaluate psychiatric symptoms, such as the Patient Health Questionnaire-9, which is used to quantify the severity of major depressive disorder. Dr. Anastasio also cautions that any such metric should not serve as a “definitive cutoff” for surgery.
Underlying Dr. Anastasio’s call for psychiatric risk-assessment protocols is the importance of developing and enhancing collaboration between orthopaedics and psychiatry, two disciplines that he says are often “considered very far removed from each other.”
Impact Science is a team of specialized subject-area experts (Life Sciences, Physical Sciences, Medicine & Humanities) who collaborate with authors, societies, libraries, universities, and various other stakeholders for services to enhance research impact. Impact Science aims to democratize science by making research-backed content accessible to the world.
Call for Submissions: JBJS What’s Important Articles
Over the last two years, JBJS has published more than 20 What’s Important articles, with topics ranging from unhappy patients to innovations in orthopaedic education. In these 1,000-word articles, clinicians tell a thoughtful and personal story about a high-impact lesson they learned at some juncture in life that altered their worldview, enhanced them personally, and positively affected the care that they provide as orthopaedic physicians.
Because they are personal in nature, “What’s Important” submissions are not subject to the usual stringent peer-review process. Instead, they are reviewed by the Editor-in-Chief, who corresponds with the author if revisions are necessary and makes the final decision regarding acceptance. The accepted manuscript is then forwarded to JBJS staff for copyediting and publication.
Authors of these articles have received many comments suggesting that readers value What’s Important articles in unique ways. If you would like JBJS to consider a “What’s Important” story for publication, please submit a manuscript via Editorial Manager. When asked to select an article type, please choose Orthopaedic Forum and include “What’s Important:” at the beginning of the title.
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