gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Does pre-operative depression and anxiety affect outcome after trapeziectomy?

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  • presenting/speaker Flossie Carpenter - Bristol Royal Infirmary, Bristol, United Kingdom
  • Thomas Fleming - Bristol Royal Infirmary, Bristol, United Kingdom
  • Julia Blackburn - Bristol Royal Infirmary, Bristol, United Kingdom
  • Rouin Amirfeyz - Bristol Royal Infirmary, Bristol, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1816

doi: 10.3205/19ifssh0868, urn:nbn:de:0183-19ifssh08687

Published: February 6, 2020

© 2020 Carpenter et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Trapeziectomy is used to treat osteoarthritis of the carpo-metacarpal joint. Depression associated with osteoarthritis is a well-established phenomenon and dissatisfaction may be linked to the patient's mood pre-operatively. The objective of this study is to explore the association of pre-operative anxiety and depression with functional outcome for thumb pain and function before and after trapeziectomy.

Methods: Twenty-two consecutive patients undergoing trapeziectomy completed pre-operative Hospital Anxiety and Depression Scale (HAD) and quickDASH (DASH) pre and post-operatively. Median results are reported. Non-parametric statistics were used to evaluate the relationship between variables.

Results and Conclusions: Twenty-two patients, 18 female and 4 males, with a median age of 63 (IQR 57, 66) years were recruited to the study. Median follow up was 38 months. Fourteen right and 8 left trapeziectomies were performed. Median pre-operative DASH was 58 (IQR 43, 70) and 18.1 (IQR 4.5, 35) post-operatively (p < 0.001).

Fourteen participants showed evidence of anxiety or depression: 6 mild, 5 moderate and 3 severe.

DASH improved by 36 points with or without evidence of anxiety or depression. Pre-operative DASH increased with HAD (p = 0.02) and across HAD categories: none 52, mild 49, moderate 61 and severe 75.

Change in DASH increased with HAD category: none 36, mild 32, moderate 34, severe 49 but no statistically significant difference among groups was seen (p = 0.59).

Post-operative DASH tends to be worse if HAD is moderate or severe, 27 and 25, than none or mild, 19 and 17.

In conclusion, the difficulty of interpreting pre-operative anxiety or depression and outcome after trapeziectomy is establishing a causal relationship. Although the greater improvement is seen the more severe pre-operative anxiety or depression, absolute post-operative function tends to be worse. This study suggests that trapeziectomy offers equal functional improvement in the presence of POAC or without.