C. Campbell1, M. Stieler1,2,3, K. Shah1, V. Thirugnanasundralingam1, P. Pockney1,2,3, G. Carter2,3 1John Hunter Hospital,Department Of Surgery,Newcastle, NSW, Australia 2University of Newcastle,Health Sciences,Newcastle, NSW, Australia 3Hunter Medical Research Institute,Newcastle, NSW, Australia
Introduction:
Undifferentiated pain, and pain out of proportion of diagnosed pathology, are conundrums to the surgeon, a source of frustration for the patient, and a significant economic burden to healthcare systems. The DSM-5 diagnosis of Somatic Symptom Disorder (SSD) has consolidated and supplanted the myriad of poorly differentiated labels previously used, including but not limited to hypochondriasis. SSD is defined as “multiple, current, somatic symptoms, that are distressing or result in significant disruption of daily life”. Studies have confirmed that hospital admissions, ED visits, primary care and specialist visits are greater in patients with SSD, and that comorbid anxiety and/or depressive disorders occur in 30-60% of primary care patients.
The prevalence of SSD has consistently been recorded at 15-20% across many populations. Despite the extensive research in primary care populations, minimal evidence has been collected in secondary care patients, especially surgical.
We hypothesized that the rates of SSD in the surgical population reflects that in primary care at 15-20%. We also hypothesized that SSD sufferers have more frequent hospital admissions, receive more investigations (blood tests and imaging), have longer admissions, and are prescribed more opioid analgesia than patients without SSD.
Methods:
Adult patients admitted with abdominal pain of any non-traumatic etiology to the Acute General Surgical Unit at a major tertiary hospital are being screened for SSD, anxiety and depression using the PHQ questionnaire. Details of the admission including investigations received, operations performed and opioid use during, and post-admission are being recorded.
We are analyzing the accuracy of the PHQ-15 to diagnose SSD in secondary care patients with a sub-analysis of surgical patients (PHQ-15 is a 15-question survey that reliably detects SSD in the primary care population).
Results:
To date, 250 participants have been recruited with a total SSD prevalence of 20%. Initial analysis of available data has shown a positive correlation between SSD and length of admission, average opioid use, primary care utilization, and an inverse relationship between SSD risk and peak WCC in the first 48hrs of admission.
Conclusion:
Our preliminary data confirms an SSD prevalence of 20% in the surgical population. This is associated with, increased surgical resource utilization, opioid use and length of admission. This suggests a need to include careful assessments of the risk of somatic symptom disorder as part of the assessment of “surgical” patients presenting to hospital. We will continue recruitment to 1000 participants by January
