Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

Abstract

Introduction: The purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty. Methods: Patients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination. Results: Total number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups. Conclusion: Patients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

What is the Association Between Clinically Diagnosed Psychiatric Illness and Total Joint Arthroplasty? A Systematic Review Evaluating Outcomes, Healthcare Use, and Patient-reported Outcome Measures

“…However, there was no difference in reported functional status during these time periods [74, 75]. In studies grouping patients with any psychiatric illness for analysis, there were no differences reported in WOMAC or Patient-Reported Outcome Measure Information System scores compared with patients without mental disorders after 1 year of follow-up [48, 54].…”

“…For the outcome measure of cost, the included studies only reported partial economic evaluations such as the total cost of hospitalization or reimbursement claims; thus, these relatively superficial analyses were deemed comparable in the quality of evidence they provided. Fifteen articles evaluated the association between perioperative complications and a diagnosed comorbid illness [11,14,15,26,42,45,46,48,59,60,70,78,83,84,95]. Eight articles reported on readmission rates after TJA [28,42,48,60,70,77,83,84].…”

Does resilience predict hospital length of stay after total knee arthroplasty? A prospective observational cohort study

“…Assessing patient-reported resilience before arthroplasty may assist clinicians to identify those who are at risk of sub-optimal outcomes after arthroplasty, who are not identified using current methods. Current methods often focus on a formal diagnosis of depression or anxiety, use of psychoactive medications, use of generic quality of life outcome measures, or diagnosis-specific outcome measures [ 12 – 15 ]. Assessing resilience may be a more sensitive method of identifying those at risk of poor outcomes, as it considers how patients respond to adversity, rather than a narrow identification of specific diagnoses [ 16 ].…”

Prediction of the quality of mental life in patients with aseptic necrosis of the femoral head with non-psychotic mental disorders

“…Встановлено, що обмеження функції та біль при ураженні кульшового суглобу більшою мірою пов'язані з особистісними та психологічними чинни-* © Шорніков А. В., Огоренко В. В., 2022 ками, неефективними копінг-стратегіями, ніж з патологічними та анатомічними чинниками [2]. Через це у пацієнтів з психічними розладами збільшується тривалість стаціонарного лікування при операціях з ендопротезування і вони частіше потребують тривалішої реабілітації [3]. Пацієнти з показаннями до ендопротезування суглобів мають більш високі показники клінічно значущих симптомів депресії до та після операції як порівняти із загальною популяцією, а операція призводить лише до помірного покращення тяжкості симптомів депресії та тривоги [4].…”

“…Під первинним спостереженням перебувало 137 осіб з АНГСК та НПР, з яких 96 дійшли до кінця дослідження, решта вибули з дослідження через відмову. Це узгоджується з даними Kooner та співавт., які спостерігали показник втрати для подальшого спостереження близько 90 % за один рік [3]. Усі обстежені надали особисту письмову інформовану згоду на участь у дослідженні.…”