Preoperative Anxiety Effect on Patient-Reported Outcomes Following Foot and Ankle Surgery

Devon C. Nixon, Kevin A. Schafer, Brian Cusworth, Jeremy J. McCormick, Jeffery E. Johnson, Sandra E. Klein

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Preoperative emotional distress has been shown to negatively influence joint arthroplasty and spine surgery, but limited data exist for foot and ankle outcomes. Emotional distress can be captured through modern tools like the Patient-Reported Outcomes Instrument Measurement System (PROMIS) anxiety domain. We hypothesized that patients with greater preoperative PROMIS anxiety scores would report greater pain and less function after foot and ankle surgery than patients with lower preoperative anxiety levels. Methods: Elective foot and ankle surgeries from May 2016 to December 2017 were retrospectively identified. PROMIS anxiety, pain interference (PI), and physical function (PF) scores were collected before and after surgery. Patients were grouped based on preoperative PROMIS scores greater or less than 59.4. A cutoff of PROMIS anxiety above 59.4 was selected as the threshold that corresponds to traditional measures of anxiety. Results: Compared to patients with less preoperative anxiety (average: 47.2, n=146), patients with higher preoperative anxiety (average: 63.9, n=59) had greater preoperative pain (PROMIS PI: 63.5 vs 59.1, P <.001) and lower physical function (PROMIS PF: 37.9 vs 42.0, P =.001). Postoperatively, patients with higher preoperative anxiety had more residual pain and greater functional disability as compared to patients with less preoperative emotional distress (PROMIS PI: 58.6 vs 52.9, P <.001; PROMIS PF: 39.8 vs 44.4, P <.001; respectively). Conclusion: Our evidence showed that preoperative emotional anxiety predicted worse pain and function at early operative follow-up. Measures of preoperative anxiety could be useful in identifying patients at risk for poorer operative outcomes, but continued study is necessary. Level of Evidence: Level III, retrospective comparative study.

Original languageEnglish
Pages (from-to)1007-1011
Number of pages5
JournalFoot and Ankle International
Issue number9
StatePublished - Sep 1 2019


  • anxiety
  • patient-reported outcomes


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