The Impact of Preoperative Anxiety/Depression on the Surgical Outcomes of Patients with Pilon Fractures: A Retrospective Study

Abstract

Objective: This study investigates the psychological status of patients with pilon fractures and analyzes the impact of preoperative psychological state on surgical outcomes. Methods: We included 121 patients with pilon fractures from April 2018 to July 2024. All completed the Chinese version of the 9-item Central Sensitization Inventory (CSI-9), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society Hindfoot Scale (AOFAS) preoperatively and postoperatively. Patients were divided into two groups: Group A (with preoperative anxiety or depression) and Group B (without). We assessed baseline data, central sensitization, pain, functional activity, and psychological status. Results: Of the 121 patients, 100 completed follow-up, with 41 (41%) showing preoperative anxiety or depression. Group A had significantly higher preoperative and final follow-up scores in central sensitization, pain, and anxiety/depression (p<0.05) compared to Group B. Group A also had worse overall prognosis. Significant differences were observed in improvements in central sensitization, pain, and anxiety/depression (p<0.05). Patients with depressive symptoms had poorer functional and pain recovery postoperatively. A significant correlation was found between postoperative pain improvement and functional activity in patients with preoperative depression (p<0.05). Conclusion: Both cohorts showed substantial improvements in pain management, psychological well-being, and central sensitization postoperatively. However, patients with preoperative anxiety or depression had inferior outcomes in postoperative pain, psychological status, and central sensitization. Preoperative depressive symptoms may impede postoperative pain improvement and functional recovery. Surgeons should prioritize mental and psychological care for patients with depression before surgery to optimize outcomes.