A prospective cohort study with 100% follow-up.
To assess incidence and risk factors for development of post-traumatic stress disorder (PTSD) symptoms after elective lumbar arthrodesis.
Invasive medical care results in substantial physical and psychological stress to patients. The reported incidence of PTSD after medical care delivery in patients treated for trauma, cancer, and organ transplantation ranges from 5% to 51%. Similar data after elective lumbar spinal arthrodesis have not been reported.
A consecutive series of 73 elective lumbar spine arthrodesis patients were evaluated prospectively, using the PTSD Checklist–Civilian Version at 6 weeks, 3 months, 6 months, 9 months, and 12 months after surgery. Patient's sex, age, education level, job status, marital status, psychiatric history, prior surgery with general anesthetic, surgical approach, blood loss, postoperative intubation, length of intensive care unit and hospital stay, and occurrence of perioperative complications were analyzed as predictors of PTSD symptoms, using χ2 analyses.
The overall incidence of symptoms of PTSD identified at at least 1 time point was 19.2% (14 of 73). At each time point, the percentage of the population that was positive was 7.5% (6 wk), 11.6% (3 mo), 7.8%, (6 mo), 13.6% (9 mo), and 11.0% (12 mo). The presence of a prior psychiatric diagnosis proved to be the strongest predictor of postarthrodesis symptoms of PTSD (odds ratio [OR] = 7.05, P = 0.002). Occurrence of a complication also proved to be significantly correlated with the development of PTSD symptoms (OR = 4.33, P = 0.04). Age less than 50 years, blood loss of more than 1 L, hospital stay of more than 10 days, and diagnosis trended toward but failed to reach statistical significance. None of the remaining variables approached statistical significance.
Positive PTSD symptoms occurred at least once in 19.2% of patients after elective lumbar arthrodesis, with 7.5% to 13.6% of patients experiencing these symptoms at any 1 time point postoperatively. In this patient cohort, preoperative psychiatric diagnosis was the strongest predictor among tested variables of occurrence of PTSD symptoms, although occurrence of a perioperative complication was also significantly correlated with PTSD symptoms. Spine surgeons should be aware of the potential impact of lumbar arthrodesis surgery on patients' psychological state. Further investigation focusing on the impact of PTSD symptoms on clinical outcomes as well as on potential means of reducing the postoperative incidence of this disorder seems warranted.
Seventy-three patients were followed for 1 year postoperatively from elective lumbar arthrodesis. Fourteen of 73 patients (19.25%) demonstrated symptoms of post-traumatic stress disorder. The strongest predictive factors were existence of a preoperative psychiatric diagnosis and occurrence of a perioperative complication.
From the Malcom Grow Medical Clinic, Andrews Air Force Base, MD
Address correspondence and reprint requests to Robert A. Hart, MD, Oregon Health & Science University, Sam Jackson Hall, Ste. 2360, 3181 SW Sam Jackson Park Rd., Portland, OR 97239; E-mail: email@example.com
Acknowledgment date: April 1, 2011. First revision date: January 23, 2012. Acceptance date: March 3, 2012.
The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work.
One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.