UC Irvine

Lumbar spine disease accounts for half of all musculoskeletal complaints and is a major contributor to pain and disability. Surgical intervention is often used as the ultimate management modality among patients with complicated spine conditions. Evidence documents a high prevalence of anxiety among patients with this disease process, and patients with anxiety who receive surgical treatment for low back pathology demonstrate worse postoperative outcomes, including more severe pain, higher rates of postoperative delirium, and increased length of hospital stay when compared to those without anxiety. Despite these known disparities, University of California, San Diego – La Jolla (UCSD – La Jolla) does not screen elective lumbar spine surgical patients for anxiety in the postoperative setting, a time when pain and disability are at their most severe. In response, this project introduced anxiety screening among this patient population using the Anxiety domain of the Hospital Anxiety and Depression Scale (HADS-A) on postoperative day one. Those patients who screened positive for anxiety were referred for osteopathic manipulative treatment (OMT), a therapy which has been shown to effectively ameliorate postoperative pain among lumbar spine patients and postoperative anxiety. This project had three outcome measures: (1) participation rate, or the percentage of patients who accepted the screening protocol, (2) anxiety prevalence, or the percentage of patients who screened positive for anxiety on the HADS-A, and (3) OMT consult rate, or the percentage of patients who received OMT prior to discharge. We screened 20 patients over a period of two weeks. We observed a participation rate of 100%, as well as an OMT consult rate of 100%. Among the 20 patients screened, 35% screened positive for anxiety, and an additional 10% screened as borderline abnormal (or having some evidence of anxiety). When considering individual items on the HADS-A, we found that the item with the highest average score was the one that asked after somatic symptoms, which reinforces the role pain plays postoperatively among this patient population. While we cannot extrapolate the results observed in this project due to the limited sample size, the suggestion that a third of postoperative lumbar spine patients may experience anxiety should act as an impetus for ongoing screening.