Gender, Ethnic Differences in Fear, Anxiety May Affect Surgical Intervention and Recovery

Orthopaedic surgeons studying gender and ethnic differences among patients undergoing joint replacement find that fear and anxiety may play a significant role in delaying surgery, resulting in increased pain and poorer preoperative functional status. In a scientific poster exhibit presented at the American Academy of Orthopaedic Surgeons' (AAOS) 70th Annual Meeting in New Orleans, La, a compilation of studies commissioned by the Orthopaedic Research and Education Foundation indicated that timing for surgical intervention is significantly linked to fear and anxiety and differs highly among genders and various ethnicities.

The overall study findings suggest that intervention to alleviate fear and anxiety before surgery would encourage females and African Americans to pursue arthroplasty surgery sooner, leading to lower preoperative pain levels and higher functionality scores, which would result in better outcomes.

According to principal investigator, Carlos Lavernia, MD, orthopaedic surgeon in Miami, Fla, " Pursuing arthroplasty surgery during the precise window of opportunity for best surgical outcomes requires the identification and alleviation of the fear and anxiety that patients experience, which may affect their surgical outcomes." This multidisciplinary approach to treatment allows for identification of conditions that may delay or prevent proper healing.

Findings also indicated that female patients pursue surgical intervention with a statistically significant lower quality of life and physical function than males do. The preoperative physical function, measured by Orthopaedic Short Form-36, indicated significant differences between genders, with females averaging a score of 10 and males averaging 20, a much higher level of functionality (p<0.05). Additionally, women demonstrated higher scores in escape and avoidance behavior according to Pain-Anxiety Symptom Scales (PASS).

Ethnic differences were illustrated in PASS scores ranging from 10.88 in the Caucasian population to 18 in the African-American population. Results from this part of the study suggest that African-American arthroplasty patients often have poorer preoperative functional status than do nonminority patients, because they tend to wait longer to surgically correct the problem. In addition, pain and anxiety scores are higher in African-Americans than in Caucasian patients.

Of the 331 patients included in the study, 66.5% were females and 33.5% were males. Of these patients, ethnic distribution varied: 12.7% African-American, 28.7% Caucasian, 55.3% Hispanic, and 3.3% multiculture. The procedures included in the study were Primary Total Hip Replacement (37.2%), Primary Total Knee Replacement (35.6%), Revision Total Hip Replacement (15.1%), and Revision Total Knee Replacement (8.8%). A number of validated outcome tools and standard orthopaedic questionnaires, SF-36 (Orthopaedic Short Form 36, to determine functionality), and PASS (Pain-Anxiety Symptom Scale) were used to assess the patients before surgery.

The 26,047-member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org ), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (http://www.usbjd.org ), the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's Annual Meeting is being held February 5-9, 2003, at the Ernest N. Morial Convention Center.