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Attitudes of Spine Surgeons Regarding Management of Preoperative Anxiety

A Cross-sectional Study

Musa, Arif, MS*; Wang, Jeffrey C., MD; Acosta, Frank L., MD; Movahedi, Rana, MD; Melkonian, Adana, MS§; Shahbazi, Alan, MS; Safani, David, MD, MBA; Gucev, Gligor, MD, EdD

doi: 10.1097/BSD.0000000000000705

Study Design: This is a cross-sectional study.

Objective: To investigate spine surgeons’ attitudes regarding preoperative anxiety measurement, management, and responsibility.

Summary of Background Data: The vast majority of patients scheduled for spine surgery experience preoperative anxiety. However, there are currently no consensus guidelines for measure or management of preoperative anxiety in spinal operations.

Materials and Methods: An anonymous questionnaire was sent online to spine surgeons of AO Spine North America to capture their views regarding preoperative anxiety.

Results: Of 69 complete responses, most respondents were male (n=66, 95.7%), orthopedic surgeons (n=52, 75.4%), and practicing at an academic setting (n=39, 56.5%). Most spine surgeons practiced for at least 20 years (n=52, 75.4%), operated on 100–300 patients per year (n=48, 69.6%), and were attending physicians (n=61, 88.4%). Most did not measure preoperative anxiety (n=46, 66.7%) and would not use a rating scale to measure it (n=38, 55.1%). However, most would discuss it if mentioned by the patient (n=40, 58.0%). Other spine surgeons measured anxiety verbally (n=22, 31.9%) or with a rating scale or survey (n=6, 8.7%). Although preferences for preoperative anxiety management varied, most respondents used patient education (n=54, 78.3%) and permitting family members’ presence (n=36, 52.2%) to reduce patient anxieties. Spine surgeons held themselves, anesthesiologists, and patients most responsible to manage preoperative anxiety.

Conclusions: The majority of spine surgeons surveyed did not regularly measure preoperative anxiety, but would discuss its management if the subject was broached by the patient. Spine surgeons relied on a variety of methods to manage a patient’s anxiety, but most preferred preoperative education and permitting the presence of family members. Responsibility for controlling preoperative anxiety was chiefly allocated to surgeons, anesthesiologists, and patients. Future avenues for research may include developing a preoperative anxiety measurement scale and management protocol specific to spine surgery.

Level of Evidence: Level IV.

*School of Medicine, Wayne State University, Detroit, MI

USC Spine Center

Department of Anesthesiology, University of Southern California, Los Angeles

§College of Osteopathic Medicine of the Pacific, Western University of the Health Sciences, Pomona

Department of Psychiatry and Human Behavior, University of California Irvine, Orange, CA

Touro College of Osteopathic Medicine, Touro College and University System, Middletown, NY

Podium presentation given at the Annual Forum for the 2017 Society for Minimally Invasive Spine Surgery, September 14–16, 2017 in Las Vegas, NV.

The authors declare no conflict of interest.

Reprints: Arif Musa, MS, School of Medicine, Wayne State University, 540 E Canfield St., Detroit, MI 48201 (e-mail:

Received January 22, 2018

Accepted June 25, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.