Impact of preoperative psychological status on clinical outcomes following percutaneous endoscopic lumbar surgery under local anesthesia: a propensity score-matched analysis.

BACKGROUND: The application of percutaneous endoscopic lumbar surgery under local anesthesia is becoming increasingly widespread; however, the impact of preoperative psychological status on surgical outcomes remains unclear. This study utilized propensity score matching to evaluate the effects of psychological distress and pain catastrophizing on clinical outcomes. METHODS: A retrospective cohort of 148 propensity-score-matched patients (74 per group) undergoing percutaneous endoscopic lumbar discectomy under local anesthesia was analyzed. Preoperative psychological status was assessed using the Hospital Anxiety and Depression Scale (HADS) and the Pain Catastrophizing Scale (PCS). Outcome measures included the Visual Analog Scale (VAS) for leg and back pain, the Oswestry Disability Index (ODI), the Modified MacNab criteria, and the achievement rate of the Minimal Clinically Important Difference (MCID) at 12 months postoperatively. RESULTS: At baseline, no significant differences were observed between the distress and non-distress groups in leg VAS (7.6 ± 2.3 vs. 7.5 ± 2.2, p = 0.681), back VAS (6.6 ± 1.3 vs. 6.5 ± 1.2, p = 0.093), or ODI (54.8 ± 9.5 vs. 53.9 ± 9.7, p = 0.594). At 12 months postoperatively, the distress group exhibited significantly higher leg VAS (3.7 ± 1.9 vs. 2.0 ± 1.1, p = 0.033), back VAS (3.1 ± 1.5 vs. 2.0 ± 1.0, p = 0.024), and ODI (31.2 ± 10.8 vs. 21.0 ± 7.5, p = 0.012) scores. The rate of MCID achievement for ODI was significantly lower in the distress group (60.8% vs. 82.4%, p = 0.015). Furthermore, the proportion of patients achieving excellent or good outcomes according to the Modified MacNab criteria was 81.1% in the distress group compared to 93.2% in the non-distress group (p = 0.021). Both HADS and PCS scores were identified as independent predictors of unsatisfactory outcomes (adjusted OR = 1.17 and 1.09, respectively; both p < 0.01). The combined clinical-psychological model demonstrated superior predictive accuracy (AUC = 0.84). CONCLUSION: Preoperative psychological distress and pain catastrophizing are independent predictors of inferior clinical outcomes following percutaneous endoscopic lumbar surgery under local anesthesia. Routine preoperative psychological screening and targeted interventions may be beneficial for optimizing surgical outcomes.