Impact of Preoperative Depression on Motor Recovery Following Brachial Plexus Reconstruction: A 24-Month Prospective Cohort Study.

BACKGROUND

Depression is frequently diagnosed in patients experiencing traumatic injury and chronic neuropathic pain. Psychological factors may undermine patient motivation, potentially adversely affecting surgical outcomes. This study aims to investigate the impact of depression on objective motor recovery following brachial plexus reconstruction.

METHODS

This prospective cohort study included 81 patients with brachial plexus injury (BPI). Depression was screened preoperatively using the Patient Health Questionnaire-9, utilizing a diagnostic threshold of ≥9. Motor recovery of elbow flexion was assessed via the Medical Research Council (MRC) grading system, with functional recovery defined as MRC ≥ 3. Patients were followed up for a minimum of 24 months. Chi-square and Fisher's exact tests were utilized to evaluate the association between depressive status and functional elbow flexion recovery.

RESULTS

The cohort included 60 patients with pan-brachial plexus injuries and 21 with upper-trunk injuries. The mean interval from injury to surgery was 5.6 ± 1.3 months. Depression was identified in 25 patients (30.8%). Overall, 42% of the cohort achieved functional motor recovery (MRC ≥ 3). While no significant association was observed between depression and recovery in the total cohort (χ2 = 1.48, P = .22), subgroup analysis of patients undergoing partial ulnar nerve transfers revealed a significant association between depression and suboptimal recovery (Fisher's exact test, P = .04).

CONCLUSIONS

Approximately one-third of BPI patients screened positive for depression. While depressive symptoms did not significantly influence recovery following intercostal or spinal accessory nerve transfers, they were associated with inferior outcomes in the partial ulnar nerve transfer subgroup. Consequently, early screening and multidisciplinary management of depression are critical components of comprehensive BPI care.