title: Depression and Anxiety in Traumatic Brachial Plexus Injury Patients Are Associated With Reduced Motor Outcome After Surgical Intervention for Restoration of Elbow Flexion.
abstract: Depression has been associated with poor outcomes in neurosurgical patients, including increased pain, poorer functional recovery, delayed return to work, and decreased patient satisfaction. No reports exist regarding an association of psychiatric diagnoses with outcomes after 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.
  
  
  
  To analyze patients undergoing brachial plexus reconstruction to assess the relationship of depression/anxiety with functional outcome.
  
  
  
  Data were collected retrospectively on all patients who underwent brachial plexus reconstruction to restore elbow flexion between 2005 and 2013. Elbow flexion, graded via the Medical Research Council 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 Medical Research Council scale score ≥3 (antigravity) vs <3 elbow flexion. Standard statistical methods were used.
  
  
  
  Thirty-seven patients met inclusion criteria. The median postsurgical follow-up time was 21 months. Operations included neurolysis (n = 3), nerve graft repair (n = 6), and nerve transfer (n = 28). Depression was present in 10 of 37 patients (27%). Of variables tested, only depression was associated with poor elbow flexion outcome (odds ratio: 6.038; P = .04).
  
  
  
  Preoperative depression is common after brachial plexus injury. The presence of depression is associated with reduced elbow flexion recovery after reconstruction. Our data suggest assessment and treatment of preoperative mental health is important in designing a comprehensive postoperative management plan to optimize outcomes and patient satisfaction.
  
  
  
  MRC, Medical Research CouncilTBI, traumatic brain injury.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wilson
authors.forename: Kate W C
authors.initials: KW
authors.lastname: Chang
authors.forename: Lynda J-S
authors.initials: LJ
authors.lastname: Yang
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D001917:Brachial Plexus / Q000293:injuries / Q000601:surgery; D020516:Brachial Plexus Neuropathies / Q000523:psychology* / Q000601:surgery*; D003863:Depression / Q000209:etiology*; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000523:psychology; D011184:Postoperative Period; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult