Introduction: Depression 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 pre-operative 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.
Methods: Data 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 (anti-gravity) versus < 3 elbow flexion. Standard statistical methods were used for analysis.
Results: During the study period, 37 patients met the inclusion criteria for the study. Mean post-surgical 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 = 0.035).
Conclusions: Pre-operative 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 pre-operative mental health is important in designing a comprehensive post-operative management plan to optimize outcomes and patient satisfaction.
Patient Care: This is the first report associating depression with poor functional outcome following brachial plexus reconstruction. Recognizing this as a potentially modifiable risk factor will allow clinicians to incorporate mental health treatment into comprehensive post-operative management plans and potentially improve functional recovery following brachial plexus reconstruction.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the high rate of depression in patients with brachial plexus injury; 2) Identify the relationship between depression and poor functional outcome following brachial plexus reconstruction; 3) Discuss the importance of incorporating mental health into a comprehensive post-operative management strategy following brachial plexus reconstruction