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Psychosocial Factors and Surgical Outcomes: An Evidence-Based Literature Review

Dr. Rosenberger is Associate Research Scientist, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT. Dr. Jokl is Professor, Department of Orthopaedics and Rehabilitation, Yale University School of Medicine. Dr. Ickovics is Associate Professor, Department of Epidemiology and Public Health, Yale University School of Medicine.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Rosenberger, Dr. Jokl, and Dr. Ickovics.

This work was supported by the following National Institutes of Health Grants: RO1 AR46299 and K24 DK070052.

Reprint requests: Dr. Jokl, Department of Orthopaedics, Yale University School of Medicine, Yale Physicians Building, 800 Howard Avenue, PO Box 208071, New Haven, CT 06520-80701.

The influence of psychosocial factors on clinical outcomes after surgery has been investigated in several studies. This review is limited to surgical outcomes studies published between 1990 and 2004 that include (1) psychosocial variables (eg, depression, social support) as predictors of outcome and that focus on (2) clinical outcomes (eg, postoperative pain, functional recovery) using (3) specific multivariate analytic techniques with (4) relevant clinical variables (eg, presurgical health status) included as covariates. Twenty-nine studies met these criteria. Results indicate that psychosocial factors play a significant role in recovery and are predictive of surgical outcome, even after accounting for known clinical factors. Attitudinal and mood factors were strongly predictive; personality factors were least predictive. The results suggest that preoperative consideration of attitudinal and mood factors will assist the surgeon in estimating both the speed and extent of postoperative recovery.

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