Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review

March, Marie K.; Harmer, Alison R.; Dennis, Sarah

doi:10.1016/j.apmr.2018.03.020

Cited by 21 publications

(20 citation statements)

References 46 publications

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“…The CCI does not capture psychiatric illness and as such we could not determine any possible mood derangement. Given that motivation and desire to participate in the rehabilitation process are strong predictors of success, the CCI is limited in this regard . It does, however, detect the presence of diabetes, which is important given that this is associated with poorer functional outcome and a need for further inpatient rehabilitation .…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Sahota

Alavinia

Kumbhare

et al. 2019

PM&R

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Background: The relationship between pain intensity, opioid consumption, and length of stay (LOS) has received little attention in primary, lower extremity joint arthroplasty patients admitted to inpatient musculoskeletal rehabilitation. Objective: To assess how initial pain and other clinical factors are associated with rehabilitation LOS. Design: Retrospective chart review. Setting: Rehabilitation hospital. Participants: One hundred ninety nine patients admitted for inpatient rehabilitation. Interventions: Not Applicable. Main Outcome Measures: Pain intensities on the Numeric Rating Scale (NRS) were completed 3 times daily and total daily opioid consumption recorded in terms of morphine equivalents (MEQ). Confounding variables included patient demographics, medical comorbidity burden using the Charlson Comorbidity Index (CCI), and early functional status as measured by the motor subscale from the Functional Independence Measure (FIM). Results: Mean day 3 NRS values of ≥5.2 and total day 3 opioid consumption of >50 MEQ were associated with a prolonged LOS by nearly 3 and 2 days, respectively. Within a multivariate linear regression, age, mean day 3 pain, comorbidity burden, and early motor functional status accounted for 36% of the variability seen in joint replacement rehabilitation LOS. With all other variables remaining constant, for every unit increase in mean day 3 pain and CCI, this amounted to an additional 5% and 4% increase to LOS, whereas each unit increase in admission motor FIM decreased estimated LOS by 3%. Conclusion: Mean pain intensity and total opioid consumption on day 3 of inpatient rehabilitation is associated with LOS. For the rehabilitation physician, this is useful information as the earlier identification of patients with poorly controlled pain can lead to directed intervention, better patient care, and significant cost savings.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Sahota

Alavinia

Kumbhare

et al. 2019

PM&R

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“…Higher health care costs in patients with PTSD are observable across a variety of settings. Costs of patients with PTSD exceed the costs of patients without PTSD by between 8% and 75% when PTSD occurred as a result of traffic accidents [11,12], and there is some evidence that poor psychological health and psychological disorders, such as PTSD, complicate clinical course even in routine surgical procedures [13]. Yet there are dissenting findings how PTSD affects the clinical course [14].…”

Section: Introductionmentioning

confidence: 99%

Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study

et al. 2020

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Background: Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. Methods: The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. Results: N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268-€3355], while reimbursement rose by €1387 [€563-€2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. Conclusion: Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.

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“…Other outcomes associated with pre-operative depression include longer hospital stays after surgery (March et al, 2018), poorer engagement in postoperative physiotherapy rehabilitation (Jack et al, 2010), and lower motivation, outcome expectations, and adherence to inpatient rehabilitation (Tung et al, 2013). For elderly orthopedic surgery patients, preoperative depressive symptomatology appears to augment the risk of adverse outcomes.…”

Section: Depressionmentioning

confidence: 99%

“…This likely affects their reporting of pain severity and duration (Sullivan et al, 2009;Birch et al, 2017), and recovery trajectories. March et al (2018) propose that process factors that reflect a person's psychological coping skills, such as pain catastrophising, may be more sensitive than symptom-based measures in detecting who will be at risk of poor recovery after TKA.…”

Section: Pain Catastrophisingmentioning

confidence: 99%

Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors

et al. 2020

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Improving Patient Outcomes Following TKA interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarized, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilization of multivariate prediction models to inform individually tailored interventions targeting a range of health conditions.

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Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review

Cited by 21 publications

References 46 publications

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

A Retrospective Study of the Association between Pain Intensity and Opioid Use with Length of Stay during Musculoskeletal Inpatient Rehabilitation after Primary Knee and Hip Arthroplasty

Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study

Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors

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