Presurgical Psychological Screening (PPS) is all about better understanding patients to improve their surgical outcomes. Surgeries can be technically successful – that is, the underlying medical condition is corrected – yet patients can be left without improvement in their symptoms. In the extreme, patients’ conditions may worsen; physical problems may be exacerbated or arise anew, cognitive difficulties or emotional distress may increase, and/or addiction to narcotics might occur because of post-operative pain.
Assessing Patient Compliance
PPS is a risk-assessment procedure through which Dr. Kauder offers opinions / predictions about the extent to which psychological factors may influence surgery results. High levels of emotional distress, substance abuse, personality disorders, and degree of willingness to comply with medical regimes, are among the psychological factors that research shows to strongly influence a patient’s surgical outcome.
Through PPS, Dr. Kauder makes recommendations about whether – for a particular patient – it appears most appropriate to operate or implant a device, delay those procedures until after other interventions are implemented, or avoid those procedures altogether. Through PPS evaluations, Dr. Kauder can provide treatment suggestions to both the referring medical clinician and the patient-candidate.
Reducing Medical Practice Risk
In addition to helping physicians to obtain good results and to avoid negative surgical consequences, PPS can reduce the likelihood of medical-malpractice litigation. Physicians who refer for PPS demonstrate that they have been cautious in decision making, not simply proceeding with operations unaware of psychological concerns that may affect their patients’ surgical responses.
Identifying potential challenges to patient compliance with treatment regimens is very important for fostering good outcomes with bariatric surgery. Through presurgical psychological screening evaluations, Dr. Kauder can recommend means to improve the likelihood of bariatric surgery patients’ treatment adherence to pre- and postsurgical regimens.
Deep Brain Stimulation (DBS) for Parkinson’s Disease
During the past decade, deep brain stimulation (DBS) for Parkinson’s disease (PD) has evolved from a last-resort treatment for advanced / medication-resistant PD to an increasingly accepted surgical option to alleviate motor symptoms. Current research indicates that between 10% and 15% of PD patients are appropriate candidates for DBS. Presurgical psychological screening evaluations can clarify many important considerations, such as the degree to which PD-related depression, executive-functioning impairment, or other neuropsychological factors might impact DBS-candidates’ presurgical and postsurgical status.
Implantable Devices: Spinal Cord Stimulators & Pain Pumps
Pain control through use of implantable devices such as spinal cord stimulator (SCS) and intrathecal pain pumps is commonplace. Empirical research investigating the psychological characteristics associated with implantable-device-outcomes is rapidly growing and promises to be quite fruitful. Pre-implantation psychological screening evaluations for this patient population can identify problematic emotional reactions, maladaptive thinking and behavior, as well as social problems that contribute to pain and disability.
Reconstructive & Cosmetic Surgeries
Research data indicate the rate of suicide among women with breast implants to be 2 to 3 times higher than that in the general population. Outcomes can be greatly enhanced for reconstructive and cosmetic surgery populations when presurgical psychological screening is completed. Figuring out whether a patient’s motivation for surgery is primarily external – that is, expecting changes in the response of others – rather than internal, is a prime focus.
With spine-surgery candidates – in addition to the assessment of their distress levels, substance abuse history, etc. – an assessment of response to, and interpretation of, pain sensations can be critically examined. With the addition of these variables, presurgical psychological screening can markedly enhance prediction of the response a given patient is likely to have to spine surgery.