The Impact of Psychological Factors on Device Removal Surgery

Background: Implant removal is a common procedure in orthopedic surgery which can be associated with many complications such as scar formation, hematoma, nerve injury, infection, and refracture. Indications for orthopedic implant removal have declined in recent years. Most studies have considered orthopedic hardware removal as an unnecessary procedure in the absence of severe complications such as nonunion. Some studies have reported the complications of orthopedic hardware removal to be ۲۴% to ۵۰% dependent on their types and locations as well as on other factors such as patient’s condition and the orthopedist’s experience. Objectives: The present study surveyed possible mental and psychological causes among patients who asked for removal procedures in spite of orthopedic surgeons’ advice and being aware of complications. Patients and Methods: Patients who had undergone plating for the treatment of radius and ulna fractures from ۲۰۱۱ to ۲۰۱۳, were told that it is not necessary to remove the plate and they were warned of all the risks of removal surgery, such as anesthesia, possible nerve or vascular damage, and the cost of surgery. Then, their tendency to remove the plate was examined based on evaluation criteria scores. Patients were divided into two groups: patients who insisted on surgery despite all the risks and patients who had little tendency or gave up after explanations. Both groups were given visual analog pain scale (VAS), symptom checklist-۹۰ (SCL-۹۰), and pain catastrophizing scale (PCS) questionnaires. The questions were explained for patients by an expert trained in the clinic and in case of ambiguity further explanations were given to the patients. The data were then entered into statistical package for the social science (SPSS) version ۲۰ for analysis. Results: A total of ۲۹ patients with plates were enrolled. The first group consisted of ۱۶ male and ۱۳ female patients. In the control group (group II), there were ۳۰ patients with no tendency for plate removal. In this group, ۱۵ patients were male and ۱۵ were female. The mean age of the first group was ۳۸.۲۵ ± ۱۱.۱۲ years and for the second group it was ۳۶.۸۲ ± ۱۲.۰۱ years. There was no significant difference between the two groups in terms of age and gender. Mean discomfort of patients was ۷.۷۵ ± ۱.۷۴ in the first and ۳.۹۶ ± ۱.۹۰ in the second group, indicating a statistically significant difference (P = ۰.۰۰۰). Mean VAS score was ۳.۹۶±۱.۲۰ in the first group and ۳.۸۰ ± ۱.۱۵ in the second group, which was not statistically significant (P = ۰.۵۹۳). Mean daily pain and discomfort was ۱۰.۶۲ ± ۳.۰۹ hours in the first and ۴.۸۶ ± ۲.۲۳ hours in the control group, indicating a statistically significant difference (P = ۰.۰۰۰). Linear regression analysis results demonstrated a significant correlation between increased VAS scores in the first group (P = ۰.۰۰۰), but it was not significant in the second group (P = ۰.۰۸۳). The results also showed that increase in time of daily pain and discomfort had a linear relationship with increased discomfort score in both groups (P = ۰.۰۰). Mean pain catastrophizing scale (PCS) score was ۱۰.۱۳ ± ۳.۶۲ in the first and ۹.۵۶ ± ۳.۰۷ in the second group, which was not statistically significant. Mean somatization score was ۵۲% ± ۶.۵۳% and ۴۷.۹۶% ± ۷.۱۷% in the first and second groups, respectively, which showed no significant differences (P = ۰.۰۱۳). Obsessive compulsive score was ۵۴.۶۳ ± ۵.۳۴ in the first and ۴۶.۶۳ ± ۴.۴۹ in the second group, which was statistically significant (P = ۰.۰۰۰). Conclusions: Mental and psychological backgrounds can affect the severity of discomfort of the implant. Given that so far the present study is the only study investigating the relationship between mental criteria and tendency of patients for implant removal, further studies with larger sample sizes seem warranted.

Keywords:

Psychological factors , Device Removal , Surgery