• Thomas J Wilson, Kate Chang, and Lynda Jun-San Yang.
• Neurosurgery. 2015 Aug 1;62 Suppl 1:222.

IntroductionDepression has been associated with poor outcomes in neurosurgical patients, with increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding the association of psychiatric diagnoses with outcomes following brachial plexus reconstruction. As outcomes and patient satisfaction become increasingly important to payers and physician reimbursement, assessing modifiable preoperative risk factors for their association with poor outcome and patient satisfaction is imperative. We retrospectively analyzed patients undergoing brachial plexus reconstruction to restore elbow flexion to assess the relationship of depression/anxiety disorders with functional outcome.MethodsData were collected retrospectively on all patients who underwent brachial plexus reconstruction with the goal of restoring elbow flexion between 2005 and 2013. Elbow flexion, graded on the Medical Research Council (MRC) scale, was assessed at latest follow-up. Multiple variables, including the presence of axis I psychiatric diagnoses, were assessed for their association with the dichotomous outcome of MRC = 3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used for analysis.ResultsDuring the study period, 37 patients met the inclusion criteria for the study. Mean postsurgical follow-up time was 21 months. Operations performed included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 (27%) patients analyzed. Of the variables tested, only depression was associated with poor elbow flexion outcome (OR 5.534; P = .035).ConclusionPreoperative depression is common in patients after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery following reconstruction. These data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction.

22 keywords...

hide…