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Ganz MP, Whittaker M, Scuderi GR. The Impact of Mental Health on Total Joint Arthroplasty Outcomes. Orthop Clin North Am 2025; 56:251-258. [PMID: 40484477 DOI: 10.1016/j.ocl.2024.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2025]
Abstract
Total hip and knee arthroplasty surgery are among the most successful orthopedic surgical interventions. However, there remains a cohort of patients who are dissatisfied with the outcome of their surgery despite measurable improvement in functional outcomes. Validated patient outcome measurement systems have depicted that patient mental health may influence a patient's interpretation of surgical outcome despite improvement in functional capability. Furthermore, patients who suffer from poor mental health may have a higher likelihood of postoperative complication that result in large socioeconomic burden. The ability of a surgeon to utilize patient health questionnaires to screen for and identify patients with mental health issues is important.
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Affiliation(s)
- Maximillian P Ganz
- Department of Orthopaedic Surgery, Long Island Jewish Valley Stream Hospital, 900 Franklin Avenue, Valley Stream, NY 11580, USA; Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Mathew Whittaker
- Department of Orthopaedic Surgery, Long Island Jewish Valley Stream Hospital, 900 Franklin Avenue, Valley Stream, NY 11580, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Giles R Scuderi
- Department of Orthopaedic Surgery, Long Island Jewish Valley Stream Hospital, 900 Franklin Avenue, Valley Stream, NY 11580, USA; Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Hlavinka WJ, Abdullah MS, Sontam TR, Chavda H, Alqazzaz A, Sheth NP. Post-Traumatic Stress Disorder as a Risk Factor for Adverse Outcomes in Total Knee Arthroplasty. J Arthroplasty 2025; 40:1567-1572.e1. [PMID: 39617271 DOI: 10.1016/j.arth.2024.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 11/23/2024] [Accepted: 11/26/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND There is a scarcity of literature concerning individuals who have existing post-traumatic stress disorder (PTSD) and their outcomes after primary total knee arthroplasty (TKA). This study compared outcomes in patients undergoing primary TKA who have a previous history of PTSD. METHODS An electronic health care database was used to identify patients diagnosed with PTSD undergoing TKA. Through 1:1 ratio propensity matching, these patients were matched with a cohort of non-PTSD (NPTSD) individuals. Postoperative parameters, including health care visits and prescriptions, were assessed within a 1-month time frame following surgery. Complications and revision rates were evaluated after one month, 6 months, one year, 2 years, and 5 years. A total of 646,186 patients undergoing primary TKA were identified. Ultimately, 7,381 patients who had PTSD were propensity matched to 7,381 NPTSD patients. RESULTS Patients who had PTSD presented to the emergency department at a higher rate than NPTSD patients within 7 days (OR [odds ratio]: 1.5; CI [confidence interval]: 1.0 to 2.4) postoperative. Within one month, cohorts were prescribed opioid analgesics at similar rates (OR: 0.9; CI: 0.8 to 1.1). Patients who had PTSD were found to have a higher number of infections within one month (OR: 1.7; CI: 1.2 to 2.6) and 5 years (OR: 1.2; CI: 1.0 to 1.5), periprosthetic fractures at 6 months (OR: 2.1; CI: 1.0 to 4.5) and one year (OR: 2.1; CI: 1. to 4.0), and higher revision rates at all time points. CONCLUSIONS Patients diagnosed with PTSD exhibited higher rates of periprosthetic infections at one month and 5 years and increased periprosthetic fracture rates at 6 months and one year after TKA compared to NPTSD patients. These findings underscore the importance of tailored early postoperative education and understanding outcomes for patients who have PTSD in contrast to those who do not have a diagnosis of PTSD.
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Affiliation(s)
- William J Hlavinka
- Texas A&M School of Medicine, Baylor University Medical Center, Department of Medical Education, Dallas, Texas
| | - Mohammed S Abdullah
- Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Tarun R Sontam
- Texas A&M School of Medicine, Baylor University Medical Center, Department of Medical Education, Dallas, Texas
| | - Hetsinhji Chavda
- Texas A&M School of Medicine, Baylor University Medical Center, Department of Medical Education, Dallas, Texas
| | - Aymen Alqazzaz
- Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Neil P Sheth
- Department of Orthopedic Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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O’Donovan F, Capobianco L, Taylor-Bennett J, Wells A. Relationships between anxiety, depression and wound healing outcomes in adults: A systematic review and meta-analysis. PLoS One 2025; 20:e0309683. [PMID: 40392872 PMCID: PMC12091741 DOI: 10.1371/journal.pone.0309683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 02/20/2025] [Indexed: 05/22/2025] Open
Abstract
OBJECTIVES To examine whether there is a relationship between anxiety and/or depression and wound healing. DESIGN Systematic review and meta-analysis. DATA SOURCES Searches were conducted on PsycINFO, MEDLINE, EMBASE, CINAHL and Web of Science on the 06-March-2023. METHODS Eligible studies explored the effects of anxiety and/or depression on wound healing in adults. Healing outcomes included time to heal and complication rates. Anxiety and depression outcomes were considered separately. RESULTS Fifty-five studies were included in the narrative synthesis (26,612,809 participants), and 26 studies in the meta-analysis. Studies utilised a range of observational and experimental designs. Wounds included in the review were: surgical, ulcer, burn and experimental wounds. The narrative synthesis gave mixed results, with some studies noting positive associations between increased anxiety or depression and wound healing, while others did not find an association. Results from the meta-analysis found no significant effect of anxiety on wound healing outcomes. However, depression was associated with significantly higher odds of delayed wound healing, OR = 2.10, [1.02, 4.33]; higher risk of wound complications, RR = 1.30, [1.11, 1.53] and increased risk of wound infection RR = 1.25, [1.09, 1.44]. CONCLUSION These findings suggest depression negatively impacts wound healing. There is less evidence for an association with anxiety, but this may be due to less research in this area. Future studies should explore the mechanism of associations between depression and wound healing to inform clinical interventions.
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Affiliation(s)
- Fiona O’Donovan
- Division of Psychological Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Psychosocial Service, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Lora Capobianco
- Division of Psychological Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Joseph Taylor-Bennett
- Division of Psychological Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Specialist Psychotherapy Service, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Adrian Wells
- Division of Psychological Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Ottesen TD, Xiang L, Adler RR, Holly KE, Clark CJ, Sepucha K, Shah SK, Kim DH, Hsu J, Chen AF, Weissman JS, Schoenfeld AJ. Patients With Moderate to Severe Dementia Who Undergo Elective TKA Face Elevated Risks of Death, Delirium, and Intensive Interventions: A Large, Propensity-weighted Database Study. Clin Orthop Relat Res 2025:00003086-990000000-02025. [PMID: 40359903 DOI: 10.1097/corr.0000000000003542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 04/22/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND Although TKA is one of the most commonly performed and successful orthopaedic interventions, its efficacy may be reduced in individuals living with dementia. Prior studies have not effectively accounted for confounding by indication or the use of intensive interventions, or considered the fact that cognitive impairment exists on a continuum and that patients with mild dementia may have different risk profiles when compared with those with moderate to severe dementia. QUESTIONS/PURPOSES (1) Are there differences in the risk of death after TKA in patients based on the severity of dementia? (2) Are there differences in intensive interventions and delirium after TKA in patients based on the severity of dementia? METHODS We used Medicare data to allow for complete surveillance of all medical encounters and events that transpired before and after TKA surgery. We retrospectively identified Medicare beneficiaries living with dementia who underwent primary elective TKA between January 1, 2017, and June 30, 2018. We used the Claims-based Frailty Index (CFI) to stratify dementia severity. Patients with CFI scores of 0.25 to 0.28 and an ICD-10 code for dementia were recorded as living with mild dementia. Patients with an ICD-10 code for dementia and CFI scores of ≥ 0.28 were classified as having moderate to severe dementia. Our cohort included 156,596 patients, with 98% (152,728 of 156,596) classified as not having dementia, 1% (2123 of 156,596) having mild dementia, and 1% (1745 of 156,596) having moderate to severe dementia. We had complete surveillance of outcomes and events after surgery for this cohort of patients. The primary outcome was death within 180 days of surgery. Intensive interventions (such as feeding tube insertion, intubation, resuscitation) and delirium were considered secondarily. We used inverse probability weights to account for confounding and compared outcomes between cohorts using Cox proportional hazards models, generalized estimation equations, and Fine and Gray models. RESULTS After adjusting for potentially confounding variables such as age, gender, and comorbidities, we found that individuals with mild dementia (HR 1.74 [95% confidence interval (CI) 1.12 to 2.70]; p = 0.01) and moderate to severe dementia (HR 3.05 [95% CI 1.80 to 5.17]; p < 0.001) both demonstrated elevated hazards of death compared with patients without dementia. Patients with mild dementia (HR 4.25 [95% CI 2.59 to 5.03]; p < 0.001) and moderate to severe dementia (HR 6.40 [95% CI 5.18 to 7.92]; p < 0.001) exhibited elevated hazards of delirium, and those with moderate to severe dementia were found to have greater hazards of one or more intensive interventions (HR 3.24 [95% CI 1.76 to 5.96]; p < 0.001). CONCLUSION We observed elevations in the risk of death and delirium in patients after TKA, irrespective of the severity of dementia and marked elevations in the likelihood of intensive interventions after surgery for those with moderate to severe dementia. We believe that TKA in patients with mild dementia should only proceed after clear communication about the increased risk of death, as well as effective management of chronic medical conditions and prophylactic enhancement of cognitive reserves. Performing TKA in patients with moderate to severe dementia might only be indicated in exceptional humanitarian circumstances. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Taylor D Ottesen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lingwei Xiang
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rachel R Adler
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kaitlyn E Holly
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clancy J Clark
- Department of Surgery, Wake Forest University Medical Center, Winston-Salem, NC, USA
| | - Karen Sepucha
- Mass General Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Samir K Shah
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Dae Hyun Kim
- Division of Gerontology, Department of Medicine, Beth Israel Lahey, Boston, MA, USA
| | - John Hsu
- Mass General Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Joel S Weissman
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Gordon AM, Nian P, Baidya J, Mont MA. Preoperative psychotherapy for primary total hip arthroplasty patients: an evaluation of its modifiability on readmissions and implant complications in patients who have depression. Hip Int 2025; 35:239-246. [PMID: 40369820 DOI: 10.1177/11207000251317655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
INTRODUCTION Few studies have evaluated nonpharmacologic interventions, including preoperative psychotherapy, in patients who have depression. We studied whether psychotherapy visits prior to total hip arthroplasty (THA) in patients with depression were associated with lower: (1) readmissions; and (2) implant complications in patients who have depression. METHODS A nationwide database was queried from 2010 to 2021. Patients who had depression were 1:1 propensity score matched based on those who had (n = 16,143) and did not have (n = 16,140) preoperative psychotherapy visits within 3 months of primary THA. These depression patients were 1:5 ratio-matched to a control cohort of patients without comorbid depression (n = 80,627). A 90-day and 2-year follow-up surveillance period was used to evaluate readmissions and implant complications, respectively. Logistic regression models computed the odds ratios (OR) of psychotherapy on readmissions and implant complications. Patients without comorbid depression served as the reference cohort. p-Values less than 0.001 were significant. RESULTS Of patients who had depression, a stepwise increase in odds of readmissions occurred for patients who had psychotherapy (6.2 vs. 5.0%, OR 1.25; p < 0.0001) and did not have psychotherapy (6.7 vs. 5.0%, OR 1.36; p < 0.0001) compared to patients who did not have depression. Compared to patients who did not have depression, patients who had depression and did not have psychotherapy experienced greater odds of aseptic loosening (1.7 vs. 0.7%, OR 2.31; p < 0.0001), periprosthetic fractures (0.5 versus 0.2%, OR 2.44; p < 0.0001), dislocations (3.7 vs. 1.6%, OR 2.39; p < 0.0001), periprosthetic joint infections (PJIs) (3.1 vs. 1.7%, OR 1.93; p < 0.0001), and all-cause THA revisions (3.6 vs. 1.5%, OR 2.44; p < 0.0001). DISCUSSION Preoperative psychotherapy may provide a modifiable benefit among patients who had depression for 2-year implant complications. This intervention may aid arthroplasty surgeons in optimising patients potentially at higher risk for adverse events.
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Affiliation(s)
- Adam M Gordon
- Questrom School of Business, Boston University, Boston, MA, USA
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Patrick Nian
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, NY, USA
| | - Joydeep Baidya
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, NY, USA
| | - Michael A Mont
- The Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
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Kostyun RO, Hackett A, Lucchio P, Witmer DK, Solomito MJ. Positive Deviance and Exploring the Role of Mental Health on Early Postoperative Recovery After Total Hip Arthroplasty: A Retrospective Analysis Using the PROMIS-10 Global Health. J Am Acad Orthop Surg 2025; 33:34-41. [PMID: 38739867 DOI: 10.5435/jaaos-d-23-01230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/29/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Mental illnesses are well-known factors that contribute to poor outcomes among total hip arthroplasty (THA) patients. However, a dichotomized mental illness diagnosis may not reflect the complex biopsychosocial factors contributing to a patient's health. Investigating patients who achieve positive outcomes despite having risk factors, known as positive deviants, may help identify protective characteristics and decrease health disparities among this growing population of patients. Using preoperative Mental Health T-scores (MHT) from the PROMIS-10 Global Health questionnaire among patients with a mental illness diagnosis, the purpose of this study was to explore whether patients with above-average MHT, or positive deviants, experienced a different immediate postoperative recovery path compared with patients with below-average MHT. METHODS This was a retrospective chart review of patients undergoing elective primary THA. Patients with a formal diagnosis of a mental health condition were divided based on their MHT (above average [AA] >50, average [A] 40 to 50, below average [BA] <40). Postsurgical parameters included total opioid consumption, self-reported pain scores, and discharge disposition. RESULTS A total of 299 patients were analyzed. After controlling for length of stay and type of mental illness, patients in the AA-MHT and A-MHT groups used 33.8 and 29.8 morphine milligram equivalents less than patients in the BA-MHT group during the inpatient stay, respectively. Patients in the AA-MHT group reported a 1.0 lower pain with activity score at discharge compared with patients in the BA-MHT group. DISCUSSION The intersection between patients with a mental illness in need of a THA is becoming more commonplace. Data suggest that patients with a mental illness who report AA-MHT on the PROMIS-10 Global Health questionnaire may represent positive deviants or those with a more positive in-hospital recovery path compared with those patients with BA-MHT. LEVEL OF EVIDENCE Diagnostic study-retrospective cohort study.
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Affiliation(s)
- Regina O Kostyun
- From the Hartford Hospital's Bone and Joint Institute, Hartford, CT (Kostyun, Lucchio, Witmer, and Solomito), the University of Connecticut School of Medicine, Farmington, CT (Hackett), and the Orthopedic Associates of Hartford, Hartford, CT (Witmer)
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Rosovsky RP, Mezue K, Gharios C, Civieri G, Cardeiro A, Zureigat H, Lau HC, Pitman RK, Shin L, Abohashem S, Osborne MT, Jaffer FA, Tawakol A. Anxiety and depression are associated with heightened risk of incident deep vein thrombosis: Mediation through stress-related neural mechanisms. Am J Hematol 2024; 99:1927-1938. [PMID: 38965839 PMCID: PMC11502251 DOI: 10.1002/ajh.27427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/08/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
Controversy exists as to whether anxiety and depression increase deep vein thrombosis (DVT) risk, and the mechanisms mediating potential links remain unknown. We aimed to evaluate the association between anxiety and depression and DVT risk and determine whether upregulated stress-related neural activity (SNA), which promotes chronic inflammation, contributes to this link. Our retrospective study included adults (N = 118 871) enrolled in Mass General Brigham Biobank. A subset (N = 1520) underwent clinical 18F-FDG-PET/CT imaging. SNA was measured as the ratio of amygdalar to cortical activity (AmygAC). High-sensitivity C-reactive protein (hs-CRP) and heart rate variability (HRV) were also obtained. Median age was 58 [interquartile range (IQR) 42-70] years with 57% female participants. DVT occurred in 1781 participants (1.5%) over median follow-up of 3.6 years [IQR 2.1-5.2]. Both anxiety and depression independently predicted incident DVT risk after robust adjustment (HR [95% CI]: 1.53 [1.38-1.71], p < .001; and 1.48 [1.33-1.65], p < .001, respectively). Additionally, both anxiety and depression associated with increased AmygAC (standardized beta [95% CI]: 0.16 [0.04-0.27], p = .007, and 0.17 [0.05-0.29], p = .006, respectively). Furthermore, AmygAC associated with incident DVT (HR [95% CI]: 1.30 [1.07-1.59], p = .009). Mediation analysis demonstrated that the link between anxiety/depression and DVT was mediated by: (1) higher AmygAC, (2) higher hs-CRP, and (3) lower HRV ( < .05 for each). Anxiety and depression confer an attributable risk of DVT similar to other traditional DVT risk factors. Mechanisms appear to involve increased SNA, autonomic system activity, and inflammation. Future studies are needed to determine whether treatment of anxiety and depression can reduce DVT risk.
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Affiliation(s)
- Rachel P. Rosovsky
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenechukwu Mezue
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charbel Gharios
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Giovanni Civieri
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Cardeiro
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Chong Lau
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Roger K. Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Lisa Shin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Psychology, Tufts University, Medford, Massachusetts, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T. Osborne
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Farouc A. Jaffer
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed Tawakol
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Mayfield CK, Abu-Zahra MS, Bolia IK, Kotlier JL, Lin EH, Gamradt SC, Weber AE, Liu JN, Petrigliano FA. Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty. Orthopedics 2024:1-8. [PMID: 39312745 DOI: 10.3928/01477447-20240918-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
BACKGROUND Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs among patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA). MATERIALS AND METHODS The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. International Classification of Diseases, Tenth Revision, diagnosis codes were used to identify MHDs. Primary outcomes included the prevalence of MHDs, perioperative opioid consumption, and 90-day risk of postoperative complications, revision, and readmission. Bivariate and multivariate regression analyses were performed to assess 90-day risk of primary endpoints while controlling for potential confounders. Statistical significance was defined as P<.05. RESULTS From 2016 to 2020, 49,997 of 144,725 (34.55%) patients undergoing primary TSA had at least one diagnosed MHD. The most prevalent were depression (17.03%), anxiety (16.75%), and substance use disorder (10.20%). Patients with a MHD had higher mean hospital costs ($75,984±$43,129 vs $73,316±$39,046, P<.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, P<.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, P<.0001). Periprosthetic fractures (odds ratio, 1.20; P=.041), dislocation (odds ratio, 1.12; P=.042), and 90-day readmission rates (odds ratio, 1.26; P<.001) were significantly higher among patients with a MHD. CONCLUSION This study found that MHDs are associated with significantly increased perioperative opioid consumption, medical and surgical complication rates, and risk of readmission after TSA. Recognition and optimization of MHDs is critical to minimizing complications and opioid consumption after TSA. [Orthopedics. 202x;4x(x):xx-xx.].
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McCahon JAS, Massaglia J, Moncman TG, Riebesell S, Parekh SG, Pedowitz DI, Daniel JN. The Influence of Resilience on Outcomes After Total Ankle Arthroplasty. Foot Ankle Spec 2024:19386400241274601. [PMID: 39292209 DOI: 10.1177/19386400241274601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA. METHODS A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively. RESULTS High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA. CONCLUSION Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Tara G Moncman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Patel AA, Kennedy D, Dupuis G, Levi JR, Weber PC. Determining the Impact of Preoperative Psychiatric Comorbidities on Readmission After Resection of Vestibular Schwannoma. Otol Neurotol 2024; 45:e602-e606. [PMID: 39142317 DOI: 10.1097/mao.0000000000004277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To determine the impact of comorbid depression on readmission after vestibular schwannoma resection. STUDY DESIGN Retrospective database analysis. SETTING National database of readmitted patients. PATIENTS The Nationwide Readmission Database (NRD) was retrospectively reviewed for patients with history of vestibular schwannoma, identified by International Classification of Disease, Ninth Revision (ICD-9) code 225.1 and ICD-10 code D33.3, who underwent surgical resection (ICD-9 04.01, ICD-10-PCS 00BN0ZZ) in 2020. INTERVENTIONS Therapeutic. MAIN OUTCOME MEASURES Need for rehabilitation, need for procedures, length of stay, cost of readmission, and insurance status. RESULTS A total of 1997 patients were readmitted after resection of vestibular schwannoma in 2020. Of these patients, 290 had history of a comorbid depressive disorder.A significantly higher proportion of patients with history of comorbid depression were transferred to a rehabilitation facility after readmission (11.30% versus 4.30%, p < 0.001). Length of stay (p = 0.227) and total readmission cost (p = 0.723) did not differ significantly, but a significantly lower proportion had private insurance (55.40% versus 64.40%, p = 0.027). CONCLUSION Depression is associated with higher utilization of postoperative rehabilitation services and higher rates of medical comorbidities, and should be considered during preoperative evaluation.
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Affiliation(s)
| | | | - Genevieve Dupuis
- Boston University School of Public Health, Boston, Massachusetts
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Portnoy AR, Chen S, Tabbaa A, Magruder ML, Kang K, Razi AE. Complications and Healthcare Cost of Total Hip Arthroplasty in Patients with Depressive Disorder. Hip Pelvis 2024; 36:204-210. [PMID: 39210573 PMCID: PMC11380535 DOI: 10.5371/hp.2024.36.3.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 09/04/2024] Open
Abstract
Purpose The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs). Materials and Methods A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A P-value less than 0.05 was considered statistically significant. Results Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, P<0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, P=0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, P<0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, P<0.001). Conclusion Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.
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Affiliation(s)
- Antoinette R Portnoy
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Shirley Chen
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ameer Tabbaa
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Kevin Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Gordon AM, Magruder ML, Schwartz J, Ng MK, Erez O, Mont MA. Preoperative Depression Screening for Primary Total Knee Arthroplasty: An Evaluation of Its Modifiability on Outcomes in Patients Who Have Depression. J Arthroplasty 2024; 39:2040-2046. [PMID: 38382629 DOI: 10.1016/j.arth.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have evaluated preoperative depression screenings in patients who have depression. We studied whether depression screenings before total knee arthroplasty (TKA) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations and readmissions; 3) implant complications; and 4) costs. METHODS A nationwide sample from January 1, 2010, to April 30, 2021, was collected using an insurance database. Depression patients were 1:1 propensity-score matched based on those who had (n = 29,009) and did not have (n = 29,009) preoperative depression screenings or psychotherapy visits within 3 months of TKA. A case-matched population who did not have depression was compared (n = 144,994). A 90-day period was used to compare complications and health-care utilization and 2-year follow-up for periprosthetic joint infections (PJIs) and implant survivorship. Costs were 90-day reimbursements. Logistic regression models computed odds ratios (ORs) of depression screening on dependent variables. P values less than .001 were significant. RESULTS Patients who did not receive preoperative screening were associated with higher medical complications (18.7 versus 5.2%, OR: 4.15, P < .0001) and ED utilizations (11.5 versus 3.2%, OR: 3.93, P < .0001) than depressed patients who received screening. Patients who had screening had lower medical complications (5.2 versus 5.9%, OR: 0.88, P < .0001) and ED utilizations compared to patients who did not have depression (3.2 versus 3.8%, OR: 0.87, P = .0001). Two-year PJI incidences (3.0 versus 1.3%, OR: 2.63, P < .0001) and TKA revisions (4.3 versus 2.1%, OR: 2.46, P < .0001) were greater in depression patients who were not screened preoperatively versus screened patients. Depression patients who had screening had lower PJIs (1.3 versus 1.8%, OR: 0.74, P < .0001) compared to nondepressed patients. Reimbursements ($13,949 versus $11,982; P < .0001) were higher in depression patients who did not have screening. CONCLUSIONS Preoperative screening was associated with improved outcomes in depression patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Adam M Gordon
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York; Questrom School of Business, Boston University, Boston, Massachusetts
| | - Matthew L Magruder
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Jake Schwartz
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Orry Erez
- Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, Brooklyn, New York
| | - Michael A Mont
- Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Fudala M, Blank L, Tabbaa A, Rodriguez A, Conway C, Lam A, Razi AE, Abdelgawad A. Depressive Disorder and Trimalleolar Fractures: An Analysis of Outcomes and Costs. Foot Ankle Spec 2024:19386400241267019. [PMID: 39066488 DOI: 10.1177/19386400241267019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Studies have suggested a strong association between depression and poor outcomes following various orthopaedic surgeries. However, depression's impact on complications following open reduction/internal fixation (ORIF) of trimalleolar fractures has not been elucidated. Therefore, this study aimed to determine whether depression is associated with higher rates of readmissions and medical complications following ORIF of trimalleolar fractures. METHODS A database query from January, 2020, through March, 2021, identifying adults who underwent trimalleolar ORIF generated 50 154 patients. Those with depression were matched 1:1 to controls without depression by age, sex, chronic obstructive pulmonary disease, anxiety, and other prominent comorbidities. Primary endpoints compared 90-day all-cause readmissions and medical complications. Odds ratios (ORs) of the effect of depression on readmissions and medical complications were calculated. RESULTS Patients with depression who underwent ORIF of trimalleolar fractures had significantly higher odds of being readmitted within 90 days of the initial procedure (OR: 1.37; P < .0001). Ninety-day odds of developing medical complications were significantly higher (OR: 4.61; P < .0001) in patients with depression compared with patients within the control group. CONCLUSION Patients with depression undergoing trimalleolar ORIF face an increased risk of readmission and multiple postoperative complications. Orthopaedic surgeons should factor depression into their preoperative evaluation, given the already high burden of complications following ORIF of trimalleolar fractures. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Maddie Fudala
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Lindsay Blank
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ameer Tabbaa
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ariel Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Charles Conway
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Amr Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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Chaudhry F, Morgan S, Kruse C, Wolfstadt J, Ekhtiari S. Effect of Depression Interventions in Patients Undergoing Total Joint Arthroplasty Without a Formal Diagnosis of Depression: A Systematic Review. J Am Acad Orthop Surg 2024; 32:647-655. [PMID: 38626430 DOI: 10.5435/jaaos-d-23-01130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/29/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE Depression is a notable contributor to suboptimal outcomes after total joint arthroplasty (TJA). We conducted a systematic review of comparative studies to review the available evidence of interventions that affected depression scores and/or outcomes for patients undergoing TJA. METHODS EMBASE, Ovid MEDLINE, PubMed, and Scopus were reviewed systematically from inception until November 15, 2022. Studies that were relevant for this review included comparative studies between patients who received an intervention within 3 months before or after their primary total hip or knee arthroplasty procedure. The interventions included a wide range of modalities, which were grouped into psychotherapy, enhanced perioperative support, and pharmacotherapy. Other interventions included physiotherapy techniques with a psychological focus, art/music-based therapy, occupational therapy support, and educational interventions. Meta-analysis was conducted for psychotherapy and enhanced support. RESULTS The final systematic review consisted of 28 relevant studies, most of which were randomized controlled trials. A total of 3,702 patients, with a mean age of 66 years, were considered, of whom 59% were female. Most of the studies reported a notable reduction in depressive symptoms and/or scores based on the interventions being analyzed. At 3 months postoperatively, psychotherapy and enhanced support both resulted in markedly better depression and function scores compared with control subjects, with psychotherapy additionally improving pain scores. CONCLUSIONS Overall, a wide range of interventions aimed at psychological optimization of patients undergoing TJA can improve depressive symptoms, pain, and function, even in the absence of a formal diagnosis of depression. Specifically, cognitive-based psychotherapy and enhanced perioperative support had the best evidence. Routine pharmacotherapy plays a limited role, if any, in the care of TJA. Additional efforts to develop pragmatic, evidence-based, and reproducible interventions are warranted to continue to optimize outcomes in TJA patients.
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Affiliation(s)
- Faran Chaudhry
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, ON (Chaudhry), the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, ON (Morgan), the Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON (Kruse), the Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON (Wolfstadt), and the Granovsky Gluskin Division of Orthopaedics, Sinai Health System, Toronto, ON (Wolfstadt, and Ekhtiari)
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15
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Johnson AH, Brennan JC, King PJ, Turcotte JJ, MacDonald JH. Comparison of Postoperative Outcomes of Patients Undergoing Total Hip and Total Knee Arthroplasty Following a Diagnosis of Dementia: A TriNetX Database Study. Arthroplast Today 2024; 27:101359. [PMID: 38585284 PMCID: PMC10995796 DOI: 10.1016/j.artd.2024.101359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/09/2024] Open
Abstract
Background As life expectancy improves for patients with dementia, the demand for mobility-improving surgeries such as total joint arthroplasty (TJA) will increase. There is little research on patients with dementia undergoing TJA, although dementia has been shown to be a risk factor for complications. The purpose of this study is to compare postoperative outcomes of patients with dementia undergoing TJA at 90 days, 2 years, and 5 years. Methods The TriNetX database was retrospectively queried for all patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were divided into cohorts by preoperative diagnosis of dementia and propensity score matched. The following outcomes were evaluated between groups at 90 days, 2 years, and 5 years postoperatively: revision, resection arthroplasty, closed reduction (THA only), femur fracture plating, and prosthetic joint infection. Readmission and manipulation under anesthesia (TKA only) were evaluated at 90 days postoperatively. Univariate and multivariate analyses were performed. Results After matching, there were no differences in demographics or comorbidities between groups. TKA (odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.42-2.15, P < .001) and THA (OR = 2.17, 95% CI 1.92-2.45, P < .001) patients with dementia were more likely to be readmitted than patients without dementia. At 2 years (OR = 2.07, 95% CI 1.14-3.77, P = .015) and 5 years (OR = 2.14, 95% CI 1.32-3.48, P = .002) postoperatively, THA patients with dementia were more likely to have proximal femur fracture plating than patients without dementia. Conclusions Patients undergoing THA with dementia had worse outcomes than patients undergoing THA without dementia and TKA with dementia. The overall rate of complications was low, and a diagnosis of dementia should not be an absolute contraindication to proceeding with TJA.
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Affiliation(s)
| | | | - Paul J. King
- Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Justin J. Turcotte
- Orthopedic and Surgical Research, Anne Arundel Medical Center, Annapolis, MD, USA
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16
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van der Linde ML, Baas DC, van der Goot TH, Vervest AMJS, Latour C. Biopsychosocial complexity in patients scheduled for elective TKA surgery: A feasibility pilot study with the INTERMED self-assessment questionnaire. Int J Orthop Trauma Nurs 2024; 53:101094. [PMID: 38508099 DOI: 10.1016/j.ijotn.2024.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Primary aim; to determine the feasibility of implementation of the INTERMED Self-Assessment (IM-SA) in adult patients scheduled for total knee arthroplasty (TKA). Secondary aim; to measure biopsychosocial complexity, referral to psychiatry or psychology in cases of complexity and to gain insight into the relation between biopsychosocial complexity and length of stay (LOS), method of discharge (MOD) and polypharmacy. METHODS A feasibility study was conducted with 76 participants in a general hospital in the Netherlands. Feasibility was determined by the number of completed questionnaires, time spent completing the questionnaire and the attitude of staff and patients towards the IM-SA. A cut off point ≥19 on the IM-SA was used to determine the prevalence of biopsychosocial complexity. A case file study was performed to check if referral to psychiatry or psychology had taken place. The Spearman's Rank Correlation Coefficient or Phi was used to determine if there was a relation between biopsychosocial complexity and LOS, MOD and polypharmacy. RESULTS All participants completed the IM-SA. The average time spent completing the questionnaire was 11.46 min (SD 5.74). The attitude towards the IM-SA was positive. The prevalence of biopsychosocial complexity was 11.84%. Referral to psychiatry or psychology did not take place. There was no relation between complexity and LOS (Spearman's rho (r) = 0.079, p = 0.499, MOD (Phi = 0.169, p = 0.173) and polypharmacy (Phi = 0.007, p = 0.953). CONCLUSION Biopsychosocial complexity can be identified in TKA patients during the pre-operative phase by using the IM-SA. Implementation of the IM-SA in a Dutch general hospital is feasible.
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Affiliation(s)
| | - D C Baas
- Department of Orthopaedic Surgery, Tergooi MC, Hilversum, the Netherlands
| | - T H van der Goot
- Department of Orthopaedic Surgery, Tergooi MC, Hilversum, the Netherlands
| | - A M J S Vervest
- Department of Orthopaedic Surgery, Tergooi MC, Hilversum, the Netherlands
| | - C Latour
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, the Netherlands
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17
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Tamate T, Nishioka S, Ry LD, Weldon RH, N AS, Nakasone CK. The influence of mental health on early outcomes following total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:1773-1779. [PMID: 38135788 DOI: 10.1007/s00402-023-05159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Poor mental health is difficult to recognize and as a result, its association with recovery from total joint arthroplasty is difficult to assess. The purpose of this study was to investigate the relationship between overall mental health scores and outcomes in the early postoperative period following unilateral total hip arthroplasty (THA). METHODS This is a retrospective review of prospectively collected data involving 142 patients who underwent primary unilateral THA. Independent variables included patient demographics and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS), Global Physical Health (GPH) and Global Mental Health (GMH) and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) scores as well as diagnoses of depression or anxiety. Dependent variables included length of stay (LOS), disposition at discharge, narcotic consumption until discharge, 6-week postoperative GPH, GMH and HOOS JR scores and magnitude of change compared to preoperative scores. Preoperative GMH and postoperative outcomes were compared using Pearson correlation coefficient, independent t-tests, Pearson's Chi-Square test, and univariate logistic regression. RESULTS Patients with preoperative GMH scores below the 25% quartile were less likely to be discharged home and resulted in lower GPH, GMH and HOOS JR scores at 6-week follow-up compared to patients with preoperative GMH scores in the top 25% quartile. However, patients with low preoperative GMH scores demonstrated a greater magnitude of improvement in both the GPH and GMH scores compared to patients in the top 25% quartile. There was no difference in opioid consumption or LOS between either groups. When comparing patients with and without depression/anxiety, no difference was seen in any of the outcomes measured. CONCLUSION Unilateral THA offers significant improvements in both physical and mental function to patients with hip osteoarthritis and poor mental health, though overall scores remain lower than in those with better mental health.
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Affiliation(s)
- Trent Tamate
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Scott Nishioka
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Lawton Dylan Ry
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Andrews Samantha N
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
- Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
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Xu G, Zou X, Dong Y, Alhaskawi A, Zhou H, Ezzi SHA, Kota VG, Abdulla MHAH, Alenikova O, Abdalbary SA, Lu H. Advancements in autologous peripheral nerve transplantation care: a review of strategies and practices to facilitate recovery. Front Neurol 2024; 15:1330224. [PMID: 38523615 PMCID: PMC10959128 DOI: 10.3389/fneur.2024.1330224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Autologous peripheral nerve transplantation, a pioneering technique in nerve injury treatment, has demonstrated remarkable progress. We examine recent nursing strategies and methodologies tailored to various anatomical sites, highlighting their role in postoperative recovery enhancement. Encompassing brachial plexus, upper limb, and lower limb nerve transplantation care, this discussion underscores the importance of personalized rehabilitation plans, interdisciplinary collaboration, and innovative approaches like nerve electrical stimulation and nerve growth factor therapy. Moreover, the exploration extends to effective complication management and prevention strategies, encompassing infection control and pain management. Ultimately, the review concludes by emphasizing the advances achieved in autologous peripheral nerve transplantation care, showcasing the potential to optimize postoperative recovery through tailored and advanced practices.
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Affiliation(s)
- Guoying Xu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Xiaodi Zou
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | | | | | | | - Olga Alenikova
- Department of Neurology, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
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Quinlan ND, Hegde V, Bracey DN, Pollet A, Johnson RM, Dennis DA, Jennings JM. Prevalence of Depressive Symptoms in Aseptic Revision Total Knee Arthroplasty Based on the Mode of Failure. Arthroplast Today 2024; 25:101298. [PMID: 38313191 PMCID: PMC10834461 DOI: 10.1016/j.artd.2023.101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/18/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024] Open
Abstract
Background Complications following total knee arthroplasty (TKA) that necessitate revision cause considerable psychological distress and symptoms of depression, which are linked to poorer postoperative outcomes, increased complications, and increased healthcare utilization. We aimed to identify the prevalence of mental health disorders and symptoms preoperatively and postoperatively in patients undergoing aseptic revision TKA and to stratify these patients based on their mechanism of failure. Methods All patients undergoing aseptic revision TKA from 2008 to 2019 with a minimum 1-year follow-up were retrospectively reviewed at a single institution. Patients (n = 394) were grouped based on 7 failure modes previously described. Patients were considered to have depressive symptoms if their Veterans RAND-12 mental component score was below 42. Preoperative and postoperative Veterans RAND-12 mental component scores at the latest follow-up were evaluated. Results Overall comparative prevalence of preoperative to postoperative depressive symptoms was 23.4%-18.8%. By mode of failure are as follows: arthrofibrosis (25.8%-16.7%), aseptic loosening (25.3%-18.9%), extensor mechanism disruption (25%-50%), failed unicompartmental knee arthroplasty (8.6%-14.3%), instability (25.7%-17.1%), osteolysis or polyethylene wear (23.1%-23.1%), and patellar failure (11.8%-23.5%). There was no difference in depressive symptoms among failure modes preoperatively (P = .376) or at the latest postoperative follow-up (P = .175). Conclusions The prevalence of depressive symptoms in revision TKA patients appears to be independent of failure mode. Surgeon awareness and screening for depressive symptoms in this patient population preoperatively with referral for potential treatment may improve early postoperative outcomes.
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Affiliation(s)
| | - Vishal Hegde
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel N. Bracey
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Aviva Pollet
- Colorado Joint Replacement at AdventHealth Porter, Denver, CO, USA
| | | | - Douglas A. Dennis
- Colorado Joint Replacement at AdventHealth Porter, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Jason M. Jennings
- Colorado Joint Replacement at AdventHealth Porter, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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20
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Chen B, Pu B, Li S, Gong Y, Dong H. The role of NSAID in mediating the effect of genetically predicted major depressive disorder on osteomyelitis: A Mendelian randomization study. J Affect Disord 2023; 341:62-66. [PMID: 37634817 DOI: 10.1016/j.jad.2023.08.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Osteomyelitis and major depressive disorder (MDD) are significant health concerns with potential interconnections. However, the underlying mechanisms linking these conditions remain unknown. This study aimed to investigate the potential mediating role of non-steroidal anti-inflammatory drug (NSAID) medication in the association between MDD and the risk of osteomyelitis. METHODS We utilized summary data from large-scale genome-wide association studies (GWAS) to perform Mendelian randomization (MR) mediation analysis. Instrumental variables were selected based on genome-wide significance, and instrumental strength was assessed using F-statistics. Univariable and multivariable MR analyses were conducted to estimate causal effects and proportions mediated by NSAID medication. RESULTS The univariable MR analysis revealed significant associations between MDD and osteomyelitis (odds ratio [OR] = 1.44, 95 % confidence interval [CI]: 1.18-1.874) and between MDD and NSAID medication (OR = 1.36, 95 % CI 1.24-1.49). In the multivariable MR analysis, the direct effect of MDD on osteomyelitis was OR 1.35 (95 % CI: 1.09, 1.67) after adjusting for NSAID medication. The proportion of mediation by NSAID medication was 23 % (95 % CI: 0.05 %, 38.6 %). CONCLUSION This MR study provides evidence for a genetically predicted causal association between MDD, NSAID medication, and osteomyelitis. The findings emphasize the need for a comprehensive approach in managing individuals with comorbid depression and osteomyelitis, considering the potential risks and benefits of NSAID medication. Future research should address limitations and explore additional mediators and confounding factors to enhance understanding of this complex relationship.
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Affiliation(s)
- Baixing Chen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Bin Pu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
| | - Shaoshuo Li
- Wuxi Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi, China.
| | - Yu Gong
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Hang Dong
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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21
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Hegde V, Bracey DN, Pollet AK, Yazdani-Farsad Y, Dennis DA, Jennings JM. Cannabis Use Does Not Affect Outcomes After Total Hip Arthroplasty. J Arthroplasty 2023; 38:1808-1811. [PMID: 36940759 DOI: 10.1016/j.arth.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cannabis use in patients undergoing arthroplasty has increased with ongoing legalization throughout the United States. The purpose of this study was to report total hip arthroplasty (THA) outcomes in patients self-reporting cannabis use. METHODS There were 74 patients who underwent primary THA from January 2014 to December 2019 at a single institution with minimum 1-year follow-up who had their self-reported cannabis use retrospectively reviewed. Patients who had a history of alcohol or illicit drug abuse were excluded. A match control was conducted based on age; body mass index; sex; Charlson Comorbidity Index; insurance status; and use of nicotine, narcotics, antidepressants, or benzodiazepines to patients undergoing THA who did not self-report cannabis use. Outcomes included Harris Hip Score (HHS), Hip Disability and Osteoarthritis Outcome Score for Joint Reconstruction (HOOS JR), in hospital morphine milligram equivalents (MMEs) consumed, outpatient MMEs prescribed, in hospital lengths of stay (LOS), postoperative complications, and readmissions. RESULTS There was no difference in the preoperative, postoperative, or change in Harris Hip Score or HOOS JR between cohorts. There was also no difference in hospital MMEs consumed (102.4 versus 101, P = .92), outpatient MMEs prescribed (119 versus 156, P = .11) or lengths of stay (1.4 versus 1.5 days, P = .32). Also, readmissions (4 versus 4, P = 1.0) and reoperations (2 versus 1, P = .56) were not different between groups. CONCLUSION Self-reported cannabis use does not influence 1-year outcomes after THA. Further studies are warranted to determine the efficacy and safety of perioperative cannabis use after THA to help guide orthopaedic surgeons in counseling patients.
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Affiliation(s)
- Vishal Hegde
- Colorado Joint Replacement, Denver, Colorado; Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Daniel N Bracey
- Colorado Joint Replacement, Denver, Colorado; Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
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Hecht CJ, Burkhart RJ, Karimi AH, Acuña AJ, Kamath AF. 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. Clin Orthop Relat Res 2023; 481:947-964. [PMID: 36730492 PMCID: PMC10097587 DOI: 10.1097/corr.0000000000002481] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/12/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies evaluating the effects of a psychiatric illness on orthopaedic surgical outcomes have yielded mixed results. Because awareness of patient comorbid mental health disorders has become increasingly important to tailor treatment plans, the aim of our systematic review was to present the findings of all studies reporting on the association between clinically diagnosed psychiatric illnesses and total joint arthroplasty (TJA) outcomes and evaluate the quality of evidence to provide a comprehensive summary. QUESTION/PURPOSE Is there a consistently reported association between comorbid psychiatric illness and (1) complication risk, (2) readmission rates, (3) healthcare use and discharge disposition, and (4) patient-reported outcome measures (PROMs) after TJA? METHODS The PubMed, EBSCO host, Medline, and Google Scholar electronic databases were searched on April 9, 2022, to identify all studies that evaluated outcomes after TJA in patients with a comorbid clinically diagnosed mental health disorder between January 1, 2000, and April 1, 2022. Studies were included if the full-text article was available in English, reported on primary TJA outcomes in patients with clinically diagnosed mental health disorders, included patients undergoing TJA without a psychiatric illness for comparison, and had a minimum follow-up time of 30 days for evaluating readmission rates, 90 days for other perioperative outcomes such as length of stay and complications, and 1-year minimum follow-up if assessing PROMs. Studies that used a mental health screening examination instead of clinical diagnoses were excluded to isolate for verified psychiatric illnesses. Additionally, systematic reviews, case reports, duplicate studies between the databases, and gray literature were excluded. Twenty-one studies were included in our final analysis comprising 31,023,713 patients with a mean age range of 57 to 69 years. Mental health diagnoses included depression, anxiety, bipolar disorder, schizophrenia, major personality disorder, and psychosis as well as concomitant mental disorders. Two reviewers independently evaluated the quality of included studies using the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean MINORS score was 19.5 ± 0.91 of 24, with higher scores representing better study quality. All the articles included were retrospective, comparative studies. Given the heterogeneity of the included studies, a meta-analysis was not performed, and results are instead presented descriptively. RESULTS Patients with schizophrenia were consistently reported to have higher odds of medical and surgical complications than patients without psychiatric illness, particularly anemia and respiratory complications. Among studies with the largest sample sizes, patients with depression alone or depression and anxiety had slightly higher odds of complications. Most studies identified higher odds of readmission among patients with depression, schizophrenia, and severe mental illness after TJA. However, for anxiety, there was no difference in readmission rates compared with patients without psychiatric illness. Slightly higher odds of emergency department visits were reported for patients with depression, anxiety, concomitant depression and anxiety, and severe mental illness across studies. When evaluating healthcare use, articles with the largest sample sizes reporting on depression and length of stay or discharge disposition found modestly longer length of stay and greater odds of nonhome discharge among patients with depression. Although several studies reported anxiety was associated with slightly increased total costs of hospitalization, the most robust studies reported no difference or slightly shorter average length of stay. However, the included studies only reported partial economic analyses of cost, leading to relatively superficial evidence. Patients with schizophrenia had a slightly longer length of stay and modestly lower odds of home discharge and cost. Likewise, patients with concomitant depression and anxiety had a slightly longer average length of stay, according to the two articles reporting on more than 1000 patients. Lastly, PROM scores were worse in patients with depression at a minimum follow-up of 1 year after TJA. For anxiety, there was no difference in improvement compared with patients without mental illness. CONCLUSION Our systematic review found that individuals with psychiatric illness had an increased risk of postoperative complications, increased length of stay, higher costs, less frequent home discharge, and worse PROM scores after TJA. These findings encourage inclusion of comorbid psychiatric illness when risk-stratifying patients. Attention should focus on perioperative interventions to minimize the risk of thromboembolic events, anemia, bleeding, and respiratory complications as well as adequate pain management with drugs that do not exacerbate the likelihood of these adverse events to minimize emergency department visits and readmissions. Future studies are needed to compare patients with concomitant psychiatric illnesses such as depression and anxiety with patients with either diagnosis in isolation, instead of only comparing patients with concomitant diagnoses with patients without any psychiatric illnesses. Similarly, the results of targeted interventions such as cognitive behavioral therapy are needed to understand how orthopaedic surgeons might improve the quality of care for patients with a comorbid psychiatric illness.
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Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J. Burkhart
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Amir H. Karimi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alexander J. Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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Lang S, Walter N, Froemming A, Baertl S, Szymski D, Alt V, Rupp M. Long-term patient-related quality of life outcomes and ICD-10 symptom rating (ISR) of patients with pyogenic vertebral osteomyelitis: What is the psychological impact of this life-threatening disease? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1810-1817. [PMID: 36920513 DOI: 10.1007/s00586-023-07616-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE We aimed to evaluate the long-term impact of the treatment of pyogenic vertebral osteomyelitis (VO) on functional outcomes and patients' quality of life (QoL) with a special focus on psychological well-being. METHODS A total of 156 patients with VO with a minimum clinical follow-up of 12 months were retrospectively identified and asked to participate. Patient-reported outcome measures were evaluated with the EuroQol five-dimension questionnaire (EQ-5D) and German Short-Form 36 (SF-36) outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Spine-specific outcomes were assessed with the Core Outcome Measure Index and the Oswestry disability index (ODI) or the Neck disability index (NDI), respectively. RESULTS From n = 156 eligible patients, n = 129 patients could be contacted and n = 40 returned questionnaires, yielding a response rate of 31.0%. The mean time from hospital discharge to follow-up was 83.0 ± 3.8 (13-193) months. Spine-specific outcomes showed mild to moderate disability. The mean physical health component score of the SF-36 (37.1 ± 16.7), the mean mental health component score (38.2 ± 14.0) and the mean EQ-5D VAS rating (57.1 ± 21.5) were significantly lower in comparison with the scores of an age-matched reference population (all p < 0.05). The mean total score of the ISR was 0.53 ± 0.23. On average, the cohort did not cross the threshold of clinically relevant symptom burden on any subscale. CONCLUSION Even almost seven years on average after completed treatment of VO, patients report impaired QoL. Assessment of psychological disorders should be implemented in clinical practice and future prospective studies.
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Affiliation(s)
- Siegmund Lang
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department for Psychosomatic medicine, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Astrid Froemming
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Susanne Baertl
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Dominik Szymski
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Effect of documented and undocumented psychiatric conditions on length of stay and discharge destination after total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:1571-1578. [PMID: 35318485 DOI: 10.1007/s00402-022-04415-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 03/01/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Length of stay (LOS) and readmissions are quality metrics linked to physician payments and substantially impact the cost of care. This study aims to evaluate the effect of documented and undocumented psychiatric conditions on LOS, discharge location, and readmission following total knee arthroplasty (TKA). METHODS Retrospective review of all primary, unilateral TKA from 2015 to 2020 at a high-volume, academic orthopedic hospital was conducted. Patients were separated into three cohorts: patients with a documented psychiatric diagnosis (+Dx), patients without a documented psychiatric diagnosis but with an actively prescribed psychiatric medication (-Dx), and patients without a psychiatric diagnosis or medication (control). Patient demographics, LOS, discharge location, and 90 days readmissions were assessed. RESULTS A total of 2935 patients were included; 1051 patients had no recorded psychiatric medications (control); 1884 patients took at least one psychiatric medication, of which 1161 (61.6%) were in the-Dx and 723 (38.4%) were in the +Dx cohort. Operative time (+Dx, 103.4 ± 29.1 and -Dx, 103.1 ± 28.5 vs. 93.6 ± 26.2 min, p < 0.001 for both comparisons) and hospital LOS stay (+ Dx, 3.00 ± 1.70 and -Dx, 3.01 ± 1.83 vs. 2.82 ± 1.40 days, p = 0.021 and p = 0.006, respectively) were greater for patients taking psychiatric medications when compared to the control group. Patients taking psychiatric medication with or without associated diagnosis were significantly more likely to be discharged to a secondary facility-22.8% and 20.9%, respectively-compared to controls, at 12.5% (p < 0.001). Ninety-day readmission rates did not differ between the control and both psychiatric groups (p = 0.693 and p = 0.432, respectively). CONCLUSION TKA patients taking psychiatric medications with or without a documented psychiatric diagnosis have increased hospital LOS and higher chances of discharge to a secondary facility. Most patients taking psychiatric medication also had no associated diagnosis. Payment models should consider the presence of undocumented psychiatric diagnoses when constructing metrics. Surgeons and institutions should also direct their attention to identifying, recording, and managing these patients to improve outcomes. LEVEL III EVIDENCE Retrospective Cohort Study.
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Walter N, Hinterberger T, Szymski D, Alt V, Rupp M. Psychological comorbidities in osteoarthritis in Germany. Sci Rep 2023; 13:2905. [PMID: 36806322 PMCID: PMC9938889 DOI: 10.1038/s41598-023-29867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/11/2023] [Indexed: 02/20/2023] Open
Abstract
Osteoarthritis is a degenerative joint disease associated with pain, loss of function and reduced quality of life. Concomitant psychological disorders can significantly influence treatment outcomes. Therefore, we aimed to answer the following research questions: (1) How has the incidence of primary coxarthrosis and gonarthrosis developed over the last decade? (2) How high is the prevalence of osteoarthritis patients with concomitant psychological diagnoses? (3) Which psychological comorbidities are most prevalent in coxarthrosis and gonarthrosis patients, respectively? For this cross-sectional study, a dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "M16.1" and "M17.1", unilateral primary coxarthrosis and unilateral primary gonarthrosis, were quantified. Prevalence rates of secondary diagnoses of the chapter F of the ICD-10 were determined. Incidences were 230.7/100,000 inhabitants for coxarthrosis and 224.2/100,000 inhabitants for gonarthrosis. Patients with psychological comorbidities constituted 9.0% of coxarthrosis cases and 8.9% of gonarthrosis cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by + 37.8% for coxarthrosis and by 17.9% for gonarthrosis. The most prevalent secondary diagnoses were affective disorders (F3), whereby numbers increased over the years. Increasing psychological comorbidities advocate for the implementation of screening tools, prevention strategies, interdisciplinary approaches and psychological support in the treatment of osteoarthritis.
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Affiliation(s)
- Nike Walter
- grid.411941.80000 0000 9194 7179Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany ,grid.411941.80000 0000 9194 7179Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Thilo Hinterberger
- grid.411941.80000 0000 9194 7179Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Dominik Szymski
- grid.411941.80000 0000 9194 7179Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Volker Alt
- grid.411941.80000 0000 9194 7179Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Shen H, He R, Zhang P, He Y, Liu Y, Wang G, Li T. Risk factors for postoperative medical morbidity and 3-month mortality in elderly patients with hip fracture following hip arthroplasty during COVID-19 pandemic. J Orthop Surg Res 2023; 18:59. [PMID: 36683026 PMCID: PMC9867902 DOI: 10.1186/s13018-023-03511-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/06/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The purpose of the current study was to investigate the incidence of postoperative medical complications and 3-month mortality in patients ≥ 70 years old with hip fracture following hip arthroplasty (HA) and independent risk factors associated with postoperative medical complications and 3-month mortality during the Coronavirus Disease 2019 (COVID-19) pandemic. METHODS A multicenter retrospective study was conducted, patients ≥ 70 years old with HA for hip fracture under general anesthesia were included during COVID-19 and before COVID-19 pandemic. The outcome was defined as postoperative medical complications and 3-month mortality. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors for postoperative medical complications and 3-month mortality. RESULTS A total of 1096 patients were included during COVID-19 pandemic and 1149 were included before COVID-19 pandemic in the study. Patients ≥ 70 years with hip fracture for HA had longer fracture to operation duration (7.10 ± 3.52 vs. 5.31 ± 1.29, P < 0.001), and the incidence of postoperative medical complications (21.90% vs. 12.53%, P < 0.001) and 3-month mortality (5.20% vs. 3.22%, P = 0.025) was higher during COVID-2019 pandemic. Multivariate logistic regression analysis showed that dementia (OR 2.73; 95% CI 1.37-5.44; P = 0.004), chronic obstructive pulmonary disease (COPD) (OR 3.00; 95% CI 1.92-4.71; P < 0.001), longer fracture to operation duration (OR 1.24; 95% CI 1.19-1.30; P < 0.001) were associated with increased risk for postoperative medical complications. COPD (OR 2.10; 95% CI 1.05-4.17; P = 0.035), dementia (OR 3.00; 95% CI 1.11-7.94; P = 0.031), postoperative medical complications (OR 4.99; 95% CI 2.68-9.28; P < 0.001), longer fracture to operation duration (OR 1.11; 95% CI 1.04-1.19; P = 0.002) were associated with increased risk for 3-month mortality. CONCLUSIONS In conclusion, we found that postoperative medical morbidity and 3-month mortality in patients with hip fracture underwent HA were 21.90% and 5.20%, respectively, during the COVID-19. COPD, dementia and longer fracture to operation duration were associated with negative outcome in patients with hip fracture underwent HA during the COVID-19.
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Affiliation(s)
- Huarui Shen
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Rui He
- grid.440164.30000 0004 1757 8829Department of Orthopedics, The Second People’s Hospital of Chengdu, Chengdu, 610021 People’s Republic of China
| | - Peng Zhang
- Department of Joint Surgery, Sichuan Province Orthopedic Hospital, Chengdu, 610045 People’s Republic of China
| | - Yue He
- Sichuan Provincial Ba-Yi Rehabilitation Center (Si Chuan Provincial Rehabilitation Hospital), Chengdu City, 631000 Sichuan Province People’s Republic of China
| | - Yingqi Liu
- Department of Spine Surgery, Chongqing Orthopedics Hospital of Traditional Chinese Medical, Chongqing, 400000 People’s Republic of China
| | - Guoyou Wang
- grid.488387.8Department of Joint Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, 646000 China
| | - Ting Li
- grid.410578.f0000 0001 1114 4286School of Pharmacy, Southwest Medical University, Luzhou, 646000 People’s Republic of China
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Walter N, Loew T, Alt V, Rupp M. Effect of functional relaxation on the quality of life in patients with periprosthetic joint infection: Protocol for a randomised controlled trial. BMJ Open 2022; 12:e066066. [PMID: 36253042 PMCID: PMC9577919 DOI: 10.1136/bmjopen-2022-066066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/07/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) is a devastating complication in orthopaedic and trauma surgery, which puts a high burden on the patients involving recurrent hospitalisation, prolonged courses of antibiotic medication, severe pain and long periods of immobility as well as high levels of psychological distress. Thus, this multicentre study aims at implementing body-oriented psychotherapy in clinical practice and evaluating its therapeutic effect on the quality of life. METHODS AND ANALYSIS A prospective, parallel two-armed randomised controlled trial with approximately n=270 patients with verified PJI treated surgically with a one-staged exchange, or a two-staged exchange will be conducted. Functional relaxation (FR) therapy will be implemented as a group therapy. FR originally belongs to the psychodynamically based body-oriented psychotherapy. Intervention techniques consist of minute movements of small joints, which are performed during relaxed expiration accompanied by an exploration of differences of body feelings. A group will include 3-8 patients, led by a specialist physiotherapist certified in FR once a week. The participants are consecutively admitted to the class and participate in 12 sessions. The control group will consist of patients receiving an unspecific 'placebo relaxation' intervention for the same duration. The primary efficacy endpoint is the mental component summary and physical component summary of quality of life assessed by the 36-Item Short Form Health Survey (SF-36) after 6 months. Secondary outcomes include SF-36 scores after 12 months, consumption of pain medication, mobility measured by the Parker mobility score and the physical activity measured by daily steps with an accelerometer (actibelt). ETHICS AND DISSEMINATION Approval from the Ethical Committee of the University Hospital Regensburg was received (file number: 21-2226-101). Written, informed consent to participate will be obtained from all participants. Results will be made available in the form of peer-reviewed publications and presentation in congresses. TRIAL REGISTRATION NUMBER DRKS00028881; German Clinical Trials Register.
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Affiliation(s)
- Nike Walter
- Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Loew
- Department of Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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Stoica CI, Nedelea G, Cotor DC, Gherghe M, Georgescu DE, Dragosloveanu C, Dragosloveanu S. The Outcome of Total Knee Arthroplasty for Patients with Psychiatric Disorders: A Single-Center Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1277. [PMID: 36143953 PMCID: PMC9502460 DOI: 10.3390/medicina58091277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: For some years, psychiatric illness has been a major factor in evaluating the results of total knee arthroplasty. As with other patient-related items, patients diagnosed with mental illness have higher costs of medical treatment, longer recovery, and longer hospital stays. The aim of this paper is to evaluate the role of mental diseases on the surgical outcome compared with the normal population. Materials and Methods: At our hospital, we undertook a retrospective study between June 2020 and January 2022. The experimental group consisted of patients with mental diseases including schizophrenia, bipolar disease, depression, substance uses, or other psychiatric disorders. The control group consisted of patients who underwent total knee arthroplasty and did not have a mental disease. Postoperative complications and length of stay were also recorded during the study. We used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Knee Society Score (KSS) as outcome measures. Results: Between June 2020 and January 2022, a total of 634 patients underwent total knee arthroplasty in our clinic, of which 239 had a mental disease. The majority of patients were female (61%), and the average length of stay was significantly longer for patients with mental illness (6.8 vs. 2.8 days). Preoperative WOMAC and KS function scores demonstrated statistically significant differences between groups (67.83 ± 17.8 vs. 62.75 ± 15.7 and 29.31 ± 19.8 vs. 34.98 ± 21.3). KS knee score did not show any significant differences preoperatively. All postoperative functional scores showed significantly better results for the control group compared to the mental illness group. Conclusions: Mental illness appears to be linked with lower TKA scores before and after the surgical procedure.
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Affiliation(s)
- Cristian Ioan Stoica
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Georgiana Nedelea
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
| | - Dragos C. Cotor
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
| | - Mihai Gherghe
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
| | - Dragos Eugen Georgescu
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of General Surgery, “Dr. Ion Cantacuzino” Clinical Hospital, 022904 Bucharest, Romania
| | - Christiana Dragosloveanu
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Serban Dragosloveanu
- Department of Orthopaedics, “Foisor” Orthopaedics Hospital, 030167 Bucharest, Romania
- “Carol Davila” Faculty of Medicine, University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Wilson JM, Schwartz AM, Farley KX, Bariteau JT. Preoperative Depression Influences Outcomes Following Total Ankle Arthroplasty. Foot Ankle Spec 2022; 15:321-329. [PMID: 32865018 DOI: 10.1177/1938640020951657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA) is increasing in incidence. While preoperative depression is known to affect outcomes following other procedures, its effect on outcomes following TAA are unknown. Therefore, the purpose of this study was to investigate this relationship. METHODS This is a retrospective cohort study using the Nationwide Readmission Database (NRD). All patients undergoing TAA were included. Two cohorts (those with and without preoperative depression) were created. Logistic regression was then performed to assess the contribution of a preoperative diagnosis of depression on rates of 90-day complications, while controlling for patient demographic and comorbid data. RESULTS Overall, 8047 patients were included, of whom, 11.4% (918) were depressed. Compared to patients without depression, patients with depression had increased odds of the following: nonhome discharge (OR 1.61, 95% CI 1.31-1.98), extended length of stay (>2 days; OR 1.34, 95% CI 1.15-1.57), prosthetic complication (OR 1.39, 95% CI 1.10-1.74), wound complication (OR 1.59, 95% CI 1.11-2.29), prosthetic joint infection (OR 1.82, 95% CI 1.06-3.15), superficial surgical site infection (OR 1.62, 95% CI 1.02-2.58), and medical complication (OR 1.32, 95% CI 1.03-1.68). DISCUSSION Depression in patients undergoing TAA is common and is associated with increased health care utilization and complications following surgery. The modifiability of depression should be investigated with future studies. LEVELS OF EVIDENCE Prognostic, Level III: Comparative study.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Kevin X Farley
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia
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Lippold B, Tarkunde YR, Cheng AL, Hannon CP, Adelani MA, Calfee RP. Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses. Arthroplast Today 2022; 15:215-219.e1. [PMID: 35774874 PMCID: PMC9237258 DOI: 10.1016/j.artd.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background This study investigated the utility of depression and anxiety symptom screening in patients scheduled for total knee arthroplasty to examine differences in active symptoms according to patients' mental health diagnoses and associated prescription medications. Material and methods This cross-sectional study analyzed 594 patients scheduled for total knee arthroplasty at a tertiary practice between June 2018 and December 2018. Patients completed Patient-Reported Outcomes Measurements Information System (PROMIS) Depression and Anxiety Computerized Adaptive Tests in clinic quantifying active symptoms. Mental health diagnoses and associated medications were extracted from health records. Statistical analysis assessed between-group differences in mean PROMIS scores and the prevalence of heightened depressive and anxiety symptoms. Results Multivariable linear regression modeling demonstrated that being diagnosed with depression without medication (β 7.1; P < .001) and with medication (β 8.6; P < .001) were each associated with higher PROMIS Depression scores. Similar modeling demonstrated that patients diagnosed with anxiety and prescribed an anxiolytic (β 8.4; P < .001) were associated with higher PROMIS Anxiety scores than undiagnosed patients. Eighty-six (15%) patients experienced heightened anxiety and/or depressive symptoms. Heightened depressive symptoms were more prevalent among those diagnosed with depression (19% without medication, 24% with antidepressant vs 5% undiagnosed: P < .001). Heightened anxiety symptoms were most prevalent among those diagnosed with anxiety and on anxiolytic medication (25% vs 7% diagnosed with anxiety without medication, 8% undiagnosed: P < .001). Conclusion One in seven arthroplasty patients screened reported heightened depressive and/or anxiety symptoms. Despite the majority of arthroplasty patients on antidepressants and anxiolytics having symptoms controlled, these patients remain at increased risk of heightened active symptoms.
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Affiliation(s)
- Brandon Lippold
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Yash R. Tarkunde
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Abby L. Cheng
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Charles P. Hannon
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Muyibat A. Adelani
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan P. Calfee
- Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Walter N, Rupp M, Baertl S, Hinterberger T, Alt V. Prevalence of psychological comorbidities in bone infection. J Psychosom Res 2022; 157:110806. [PMID: 35367917 DOI: 10.1016/j.jpsychores.2022.110806] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Bone infections represent a major complication in orthopedic and trauma surgery. Concomitant psychological disorders can significantly influence treatment outcomes. However, these are often overlooked. Therefore, we aimed to determine the nationwide epidemiology of fracture-related infection (FRI) and osteomyelitis in combination with psychological comorbidities. METHODS A dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "T84.6, infection and inflammatory reaction due to internal fixation device" and "M86.-, osteomyelitis" were quantified. Proportions of secondary diagnoses of the chapter F of the ICD-10 were determined. RESULTS Incidences were 19.1/100,000 inhabitants for osteomyelitis and 10.5/100,000 inhabitants for FRI. Patients with psychological comorbidities constituted 14.6% of osteomyelitis cases and 26.5% of FRI cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by 27.3% for osteomyelitis and by 24.1% for FRI. Most prevalent secondary diagnoses were organic, including symptomatic, mental disorders (F0), affective disorder (F3) and mental and behavioral disorders due to psychoactive substance use (F1), whereby the latter decreased over the years. CONCLUSION The implementation of prevention strategies, interdisciplinary approaches and psychological support in orthopaedics and trauma surgery is warranted.
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Affiliation(s)
- Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany; Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany.
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Baertl
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thilo Hinterberger
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Hoch C, Pire J, Scott DJ, Gross CE. The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221108137. [PMID: 35770145 PMCID: PMC9234850 DOI: 10.1177/24730114221108137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores. Methods: We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months. Results: BRS weakly correlated with decreased postoperative benzodiazepine use ( P=.007). PCS magnification ( P=.050) and helplessness ( P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities). Conclusion: BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Caroline Hoch
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan Pire
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel J. Scott
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher E. Gross
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
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Passano B, Oakley CT, Singh V, Lygrisse KA, Schwarzkopf R, Lajam CM. Documented and Undocumented Psychiatric Conditions Affect the Length of Stay and Discharge Disposition Following Total Hip Arthroplasty. J Arthroplasty 2022; 37:727-733. [PMID: 34896552 DOI: 10.1016/j.arth.2021.11.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite increased efforts toward patient optimization, some patients have undocumented conditions that can affect costs and quality metrics for institutions and physicians. This study evaluates the effect of documented and undocumented psychiatric conditions on length of stay (LOS) and discharge disposition following total hip arthroplasty (THA). METHODS A retrospective review of all primary THAs from 2015 to 2020 at a high-volume academic orthopedic specialty hospital was conducted. Patients were separated into 3 cohorts: patients with a documented psychiatric diagnosis (+Dx), patients without a documented psychiatric diagnosis but with an actively prescribed psychiatric medication (-Dx), and patients without a psychiatric diagnosis or medication (control). Patient demographics, LOS, and discharge disposition were assessed. RESULTS A total of 5309 patients were included; 3048 patients had no recorded psychiatric medications (control); 2261 patients took at least 1 psychiatric medication, of which 1513 (65.9%) and 748 (34.1%) patients were put in the -Dx and +Dx cohorts, respectively. American Society of Anesthesiologists class differed between groups (P < .001). The -Dx and +Dx groups had increased LOS (3.15 ± 2.37 [75.6 ± 56.9] and 3.12 ± 2.27 [74.9 ± 54.5] vs 2.42 ± 1.70 [57.6 ± 40.8] days (hours), P < .001) and were more likely to be discharged to a secondary facility (23.0% and 21.7% vs 13.8%, P < .001) than the control group. Outcomes did not significantly differ between the -Dx and +Dx cohorts. CONCLUSION Most THA patients' psychiatric diagnoses were not documented. The presence of psychiatric medications was associated with longer LOS and a greater likelihood of discharge to secondary facilities. This has implications for both cost and quality metrics. Review of medications can help identify and optimize these patients before surgery. LEVEL III EVIDENCE Retrospective Cohort Study.
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Affiliation(s)
- Brandon Passano
- Department of Orthopedic Surgery, NYU Langone Hospital - Long Island, Mineola, NY
| | | | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Bourget-Murray J, Parkar A, Railton P, Evaniew N, Powell J. Effects of Perioperative Selective Serotonin Reuptake Inhibitor Use in Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2022; 37:454-459. [PMID: 34775004 DOI: 10.1016/j.arth.2021.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The aim of this study is to compare functional outcomes and perioperative complications between patients on a selective serotonin reuptake inhibitor (SSRI) and those who are not on an SSRI preoperatively at the time of total joint arthroplasty. METHODS A retrospective study was performed on 28,386 patients who received a primary total hip (THA) or knee (TKA) arthroplasty. Patients were compared based on SSRI utilization. We measured patient-reported function and health-related quality of life using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the EuroQol-5 Dimensions (EQ-5D-5L) instruments. Chi-squared test was used to compare categorical variables and t-test was used to compare the continuous variables of 2 study groups. RESULTS Patients on SSRIs have lower preoperative baseline WOMAC and EQ-5D-5L scores than those not using SSRI (P < .001). Patient-reported outcomes improved significantly following surgery, but functional outcome scores remained inferior in patients using SSRI. After adjusting for baseline variables, SSRI use in TKA predicted lower EQ-5D-5L scores than non-SSRI users (P = .036) while the WOMAC scores were not different (P = .118). For the THA cohort, SSRI use predicted lower EQ-5D-5L (P = .001) and WOMAC scores than non-SSRI users (P = .008). SSRI use was associated with increased transfusion rate, length of stay, readmission rate, and medical events. About 11.3% of TKA and 13.3% of THA patients stopped using SSRI at 12 months after arthroplasty. CONCLUSION Patients using an SSRI show improvement comparable to patients not on an SSRI, but their 12-month functional scores continue to be inferior. SSRI utilization was associated with increased adverse events including needing a blood transfusion.
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Affiliation(s)
- Jonathan Bourget-Murray
- Division of Orthopaedic Surgery, Department of Surgery, Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Asif Parkar
- Division of Orthopaedic Surgery, Department of Surgery, Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Pam Railton
- Division of Orthopaedic Surgery, Department of Surgery, Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - Nathan Evaniew
- Division of Orthopaedic Surgery, Department of Surgery, Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
| | - James Powell
- Division of Orthopaedic Surgery, Department of Surgery, Alberta Bone and Joint Health Institute, Calgary, Alberta, Canada
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Ahluwalia SS, Lugo JD, Gordon AM, Golub IJ, Razi AE, Feliccia J, Kang KK. The association of dementia on perioperative complications following primary total hip arthroplasty for femoral neck fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:971-976. [PMID: 35230544 DOI: 10.1007/s00590-022-03236-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Studies evaluating the association of dementia in patients undergoing total hip arthroplasty (THA) for femoral neck fractures are limited. The aim was to investigate whether patients who have dementia undergoing THA for femoral neck fractures have higher rates of (1) in-hospital lengths of stay (LOS); 2) complications (medical and prostheses-related); and 3) healthcare expenditures. METHODS A retrospective query using the PearlDiver database from January 1st, 2005 to March 31st, 2014 to identify patients with dementia undergoing primary total hip arthroplasty for the treatment of femoral neck fractures was performed. Dementia patients were 1:5 ratio matched to controls which yielded 22,758 patients in the study with (n = 3,798) and without (n = 18,960) dementia. Primary outcomes included comparing LOS, complications, and costs. A logistic regression was constructed to calculate the odds-ratios (OR) of dementia on complications. A p-value less than 0.004 was significant. RESULTS Dementia patients had longer LOS (7-days vs. 6-days, p < 0.0001) and higher incidence and odds of medical complications (41.52 vs. 17.77%; OR 3.76, p < 0.0001), including cerebrovascular events (5.66 vs. 1.64%; OR 2.35, p < 0.0001), pneumoniae (9.98 vs. 3.82%; OR 1.82, p < 0.0001), and acute kidney injury (8.37 vs. 3.27%; OR 1.62, p < 0.0001). Study group patients had higher frequency of prostheses-related complications (9.53 vs. 8.31%; OR: 1.16, p = 0.012). The study group had greater total healthcare expenditures ($28,879.57 vs. $26,234.10, p < 0.0001) when analyzing ninety-day episode of care charges. CONCLUSION Patients with dementia undergoing THA due to femoral neck fracture have increased LOS, medical and prostheses-related complications, and cost of care compared to their counterparts.
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Affiliation(s)
- Sukhpreet S Ahluwalia
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Javier Dejesus Lugo
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | - Adam M Gordon
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA.
| | - Ivan J Golub
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Joseph Feliccia
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Kevin K Kang
- Maimonides Medical Center, Department of Orthopaedic Surgery, 927 49th Street, Brooklyn, NY, 11219, USA
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Srikumar S, Feingold JD, Swartwout EL, Roberts SA, Ranawat AS. The predictive value of self-reported allergies for reoperation after index hip arthroscopy. J Hip Preserv Surg 2022; 9:22-27. [PMID: 35651712 PMCID: PMC9142203 DOI: 10.1093/jhps/hnac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study is to compare the rate of reoperation after index hip arthroscopy for symptomatic femoroacetabular impingement in patients with, and without, at least one self-reported allergy. Data were collected prospectively in 1468 patients whose records were retrospectively reviewed. After the application of inclusion and exclusion criteria, two cohorts were formed: (i) a study cohort (n = 261) composed of patients with a self-reported allergy and (ii) a control cohort. (n = 666). The allergy cohort had a significantly larger [P < 0.001] reoperation rate (24.1% [63/261]) compared to the control cohort (9.6% [64/66]). Univariate analysis (UVA) and multivariate analysis (MVA) were then performed to better understand the implications of allergy status on the arthroscopic outcome. On UVA the presence of an allergy increased the odds of reoperation after index hip arthroscopy by 2.99 [OR (95% CI): 2.99 (2.04, 4.39); P < 0.001] and for each additional allergy a patient reported, their odds of subsequent surgery increased by 1.27 per allergy [OR (95% CI): 1.27 (1.15, 1.39); P < 0.001]. However, on the MVA, allergy status was not an independent risk factor for reoperation. These findings suggest that allergy status is associated with a higher reoperation rate, however, allergy status alone cannot prognosticate the risk of subsequent surgery. Therefore, allergy status and its association with future surgery after hip arthroscopy should be considered in the context of multiple patient-specific factors that influence the surgical outcome. An understanding of this association enables patient-centered care and will strengthen the physician–patient relationship.
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Affiliation(s)
| | - Jacob D Feingold
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Erica L Swartwout
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Sacha A Roberts
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Anil S Ranawat
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Jeschke E, Citak M, Halder AM, Heller KD, Niethard FU, Schräder P, Zacher J, Leicht H, Malzahn J, Günster C, Gehrke T. Blood transfusion and venous thromboembolism trends and risk factors in primary and aseptic revision total hip and knee arthroplasties: A nationwide investigation of 736,061 cases. Orthop Traumatol Surg Res 2022; 108:102987. [PMID: 34144253 DOI: 10.1016/j.otsr.2021.102987] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Over the last years, new transfusion guidelines and pharmaceuticals have been introduced in primary and revision total hip and knee arthroplasty (P-THA, P-TKA, R-THA, R-TKA). In the US, a substantial decrease in transfusions has been observed in recent years. Little data exists on the subject in Europe. In this context we aimed to analyze: (1) Is there also a significant decrease in blood transfusion for these procedures in Germany? (2) Which patient and hospital related factors are associated with the risk of blood transfusion? (3) Is there a trend in complications, especially venous thromboembolism and stroke events that can be linked to tranexamic acid use? HYPOTHESIS There is a significant trend in decreasing blood transfusions in hip and knee arthroplasty. METHODS Using nationwide healthcare insurance data for inpatient hospital treatment, 736,061 cases treated between January 2011 and December 2017 were included (318,997 P-THAs, 43,780 R-THAs, 338,641 P-TKAs, 34,643 R-TKAs). Multivariable logistic regression was used to model the odds of transfusion as a function of the year of surgery. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS In each cohort the odds of transfusion decreased over time (2017 vs. 2011 (reference): P-THA: OR 0.42 (95%CI: 0.39-0.45), P-TKA: OR 0.41 (95%CI: 0.37-0.46), R-THA: OR 0.52 (95%CI: 0.47-0.58), R-TKA: OR 0.53 (95%CI: 0.46-0.61). Patient-related risk factors for blood transfusion included older age, female gender, lower Body Mass Index, comorbidities such as renal failure, cardiac arrhythmia, congestive heart failure, valvular disease, coagulopathy, depression, and antithrombotic medication prior to surgery. Venous thromboembolism or stroke events did not increase over the study period. DISCUSSION The incidence of blood transfusions in primary and revision TKA and THA decreased over the study period. This may be due to new transfusion guidelines and the introduction of novel pharmaceuticals such as tranexamic acid. A further improved patient blood management and a focus on vulnerable patient groups might lead to a further future reduction of transfusions, especially in R-THA. LEVEL OF EVIDENCE III; comparative observational study.
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Affiliation(s)
- Elke Jeschke
- Research Institute of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany.
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767 Hamburg, Germany
| | - Andreas M Halder
- Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Waldhausstraße 44, 16766 Sommerfeld/Kremmen, Germany
| | - Karl-Dieter Heller
- Department of Orthopaedic Surgery, Herzogin Elisabeth Hospital, Leipziger Straße 24, 38124 Braunschweig, Germany
| | - Fritz U Niethard
- German Society of Orthopedics and Orthopedic Surgery, Straße des 17. Juni 106-108, 10623 Berlin, Germany
| | - Peter Schräder
- Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Hauptstraße 30, 64342 Seeheim-Jugenheim, Germany
| | - Josef Zacher
- Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Hauptstraße 30, 64342 Seeheim-Jugenheim, Germany
| | - Hanna Leicht
- Helios Kliniken GmbH, Friedrichstrasse 136, 10117 Berlin, Germany
| | - Jürgen Malzahn
- Federal Association of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Christian Günster
- Research Institute of the Local Health Care Funds, Rosenthaler Straße 31, 10178 Berlin, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767 Hamburg, Germany
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Hegde V, Bracey DN, Johnson RM, Dennis DA, Jennings JM. Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection. Arthroplast Today 2022; 13:69-75. [PMID: 34977309 PMCID: PMC8685908 DOI: 10.1016/j.artd.2021.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience psychological distress and symptoms of depression, both of which are linked to poor postoperative outcomes. We, therefore, aim to identify the prevalence of depression and depressive symptoms in patients before treatment for PJI and their link to functional outcomes. Methods Patients undergoing either debridement with implant retention (DAIR) or 2-stage exchange for PJI with minimum 1-year follow-up were retrospectively reviewed. The 2-stage (n = 37) and single-stage (n = 39) patients that met inclusion criteria were matched based off age (±5 years), gender, and body mass index (±5) to patients undergoing aseptic revisions. Outcomes evaluated included a preoperative diagnosis of clinical depression and preoperative and postoperative Veterans RAND 12 Item Health Survey mental component score and physical component score. Results Compared to matched controls, the prevalence of depressive symptoms was significantly greater in patients undergoing 2-stage exchange preoperatively (40.5% vs 10.8%, P < .01) but not postoperatively (21.6% vs 10.8%, P = .20). Patients undergoing DAIR with either preoperative depressive symptoms (31.3 vs 40.9, P = .05) or a preoperative diagnosis of depression (27.7 vs 43.1, P < .01) had significantly lower physical component scores postoperatively. Conclusions Patients undergoing 2-stage exchange for PJI have a four times higher prevalence of preoperative depressive symptoms than patients undergoing aseptic revision. Patients undergoing DAIR with depression or preoperative depressive symptoms have lower functional scores postoperatively. Orthopedic surgeon screening of PJI patients with referral for treatment of depression may help improve outcomes postoperatively.
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Affiliation(s)
- Vishal Hegde
- Colorado Joint Replacement, Denver, CO, USA
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Daniel N. Bracey
- Colorado Joint Replacement, Denver, CO, USA
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | | - Douglas A. Dennis
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
- Department of Orthopaedics, University of Colorado School of Medicine, Denver, CO, USA
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
- Corresponding author. 2535 S Downing St. Suite 100, Denver, CO 80210. Tel.: 303-260-2940.
| | - Jason M. Jennings
- Colorado Joint Replacement, Denver, CO, USA
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA
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Itoh M, Itou J, Kuwashima U, Okazaki K. Correlation of patient-reported numbness around surgical scars with patient-reported outcome measures and joint awareness after knee replacement: a cohort study. BMC Musculoskelet Disord 2022; 23:14. [PMID: 34980073 PMCID: PMC8725250 DOI: 10.1186/s12891-021-04971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023] Open
Abstract
Background Knee replacement is a very effective and indispensable treatment option for end-stage knee arthritis, and the number of cases has been increasing worldwide. A replaced knee joint without patient joint awareness is thought to be the ultimate goal of artificial knees. Joint awareness reportedly correlates with patient satisfaction. Although numbness around a replaced knee is a minor but common problem, its effect on postoperative outcome is controversial. Joint awareness also is sensitive to subtle abnormalities of the joint, so it must be negatively affected by numbness. Although numbness is minor, it cannot be ignored to further improve knee replacement outcomes. This study investigated the relationship between patient-reported numbness and other patient-reported outcome measures (PROMs), including joint awareness, and kneeling. We developed a numbness score based on a 5-point Likert scale on frequency of numbness, with an intraclass correlation coefficient of 0.76 and higher scores indicating less numbness. Methods The numbness score, New Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score-12 (FJS-12), and other clinical and radiological data from 311 patients (394 primary knee replacements) were analyzed. Kneeling ability was evaluated by using kneeling-specific items in the KSS (KSS-Kneeling). Results No numbness was found in 170 knees (43.1%), and some degree of numbness was found in the remaining 224 knees (56.9%). The numbness score showed weak-to-moderate correlations with KSS-Symptoms (r = 0.44), KSS-Satisfaction (r = 0.41), KSS-Activities (r = 0.29), and all KOOS subscales (r = 0.23–0.44), and FJS-12 (r = 0.42). Multiple regression analyses suggested that midline incision positively affected the numbness score over the anteromedial incision (p = 0.04) and that a better numbness score (p = 0.001), male sex (p < 0.0001), and better postoperative knee flexion angle (0.04) positively affected kneeling. Conclusions The numbness score positively correlated with PROMs and positively affected kneeling. Knee replacements performed via an anteromedial incision may be at higher risk for numbness. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04971-6.
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Affiliation(s)
- Masafumi Itoh
- Department of Orthopaedic surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Junya Itou
- Department of Orthopaedic surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Umito Kuwashima
- Department of Orthopaedic surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Okazaki
- Department of Orthopaedic surgery, Tokyo Women's Medical University, 8-1, Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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Anis HK, Warren JA, Klika AK, Navale SM, Zhou G, Barsoum WK, Higuera CA, Piuzzi NS. Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action. J Knee Surg 2022; 35:190-197. [PMID: 32659814 DOI: 10.1055/s-0040-1713756] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) primary total knee arthroplasty (pTKA), (2) septic revision total knee arthroplasty (rTKA), and (3) aseptic revision total knee arthroplasty (TKA). The State Inpatient Databases were queried for all TKAs from 2005 to 2014 yielding 563,144 patients. Patients were separated into the following cohorts: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition and the following specific conditions were compared between the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention deficit hyperactivity disorder/conduct/impulse control, alcohol abuse, and drug abuse. Throughout the study period, an increase in the prevalence of mental health conditions was observed in septic and aseptic revision patients. Overall, there was a significantly higher prevalence of mental health conditions in the septic revision cohort (22.7%) compared with the primary (17.8%, p < 0.001) and aseptic revision (20.0%, p < 0.001) cohorts. Specifically, septic revision TKA patients had a higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), drug abuse (p < 0.001), schizophrenia (p = 0.0007), and bipolar disorder (p < 0.001), compared with primary TKA patients. Additionally, there was a significantly higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), and drug abuse (p < 0.001) among septic revision patients compared with aseptic revision patients. Mental health conditions were significantly higher among septic revision patients. Alcohol and drug abuse were approximately twice as prevalent in septic revision patients compared with primary and aseptic revision patients. These findings should serve as a call to action for mental health support for patients suffering from PJI.
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Affiliation(s)
- Hiba K Anis
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jared A Warren
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Guangjin Zhou
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Wael K Barsoum
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Hernandez NM, Cunningham DJ, Jiranek WA, Bolognesi MP, Seyler TM. Total Knee Arthroplasty in Patients with Dementia. J Knee Surg 2022; 35:26-31. [PMID: 32462643 DOI: 10.1055/s-0040-1712086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p ≤ 0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p ≤ 0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.
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Affiliation(s)
| | | | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Reddy NC, Prentice HA, Paxton EW, Hinman AD, Lin AG, Navarro RA. Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3. J Bone Joint Surg Am 2021; 103:2032-2044. [PMID: 34495903 DOI: 10.2106/jbjs.20.02110] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although safety in same-day discharge total joint arthroplasty (TJA) has been reported, findings are limited to healthier patients, specific surgeons, and/or specific institutions. Indications for same-day discharge TJA have expanded to include patients with multiple comorbidities; however, safety in this specific patient population remains unknown. Therefore, we sought to compare the risk of 90-day adverse events in higher-risk patients undergoing same-day discharge versus inpatient TJA. METHODS The Kaiser Permanente Total Joint Replacement Registry was utilized to conduct a cohort study. All patients with an American Society of Anesthesiologists (ASA) classification of ≥3 who underwent primary elective TJA for osteoarthritis from 2017 through 2018 were identified. The risk of 90-day adverse events (i.e., emergency department visits, unplanned readmissions, complications, and mortality) was evaluated with use of propensity score-weighted Cox proportional hazard regression including noninferiority testing with a margin of 1.10. RESULTS The cohort included a total of 5,250 patients who underwent total hip arthroplasty and 9,752 patients who underwent total knee arthroplasty, of whom 1,742 (33.2%) and 3,283 (33.7%) had same-day discharge, respectively. Same-day discharge hip arthroplasty was noninferior to an inpatient stay in terms of emergency department visits (hazard ratio [HR], 0.73; 1-sided HR 95% upper bound [UB], 0.84), readmissions (HR, 0.47; 95% UB, 0.61), and complications (HR, 0.63; 95% UB, 0.75); we did not have evidence of noninferiority for mortality (HR, 0.84; 95% UB, 1.97). Same-day discharge knee arthroplasty was noninferior to an inpatient stay in terms of emergency department visits (HR, 0.79; 95% UB, 0.87), readmission (HR, 0.80; 95% UB, 0.95), complications (HR, 0.72; 95% UB, 0.82), and mortality (HR, 0.53; 95% UB, 1.03). CONCLUSIONS We found that same-day discharge TJA did not increase the risk of emergency department visits, unplanned readmissions, and complications compared with an inpatient stay for higher-risk patients, suggesting that it is possible to expand indications for same-day discharge TJA in the hospital setting while maintaining safety. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nithin C Reddy
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, California
| | - Heather A Prentice
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
| | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, California
| | - Abraham G Lin
- Department of Orthopaedics, Southern California Permanente Medical Group, Irvine, California
| | - Ronald A Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, Harbor City, California
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Kim H, Kim CH. Association Between Preoperative Depression and Readmission Rate Following Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2021; 36:3807-3813. [PMID: 34244031 DOI: 10.1016/j.arth.2021.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/29/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To date, no meta-analysis of the relationship between hospital readmission after total joint arthroplasty (TJA) and preoperative depression has been conducted. Hence, this systematic review and meta-analysis aimed to evaluate the association of preoperative depression with the readmission rate following TJA. METHODS We systematically searched MEDLINE, EMBASE, and Cochrane Library for studies published before March 28, 2021, which compared readmission rates in patients with or without preoperative depression who underwent TJA. The primary outcome was the relationship between preoperative depression and 30-day and 90-day readmission rates after TJA. We also performed surgery type subgroup analyses for total hip arthroplasty, total knee arthroplasty (TKA), total shoulder arthroplasty, and total ankle arthroplasty. RESULTS We included 9 studies with 395,815 TJA cases, of which 49,402 were diagnosed with preoperative depression and 346,413 were not. In pooled TJA analysis, the 30-day and 90-day readmission rates were significantly higher in the depression group than in the no-depression group (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.26-2.73, P = .002 and OR 1.27, 95% CI 1.14-1.43,; P < .001, respectively). In the subgroup analyses, the 90-day readmission rate was higher in the depression group than in the no-depression group after TKA (OR 1.28, 95% CI 1.15-1.42, P < .001). There were no differences in other surgery types. CONCLUSION Based on available evidence, preoperative depression increases the readmission rate after TJA, particularly TKA. As depression is a modifiable risk factor, screening for depression and referring patients for proper psychiatric management are important. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Chen J, Li JY, Tian GH, Qiu RJ, Zhao XQ, Di XS, Yuan QM, Long SW, Ran Y, Jia YS, Shang HC. A national snapshot of the impact of clinical depression on post-surgical pain and adverse outcomes after anterior cervical discectomy and fusion for cervical myelopathy and radiculopathy: 10-year results from the US Nationwide Inpatient Sample. PLoS One 2021; 16:e0258517. [PMID: 34653189 PMCID: PMC8519476 DOI: 10.1371/journal.pone.0258517] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 12/27/2022] Open
Abstract
Depression is associated with poorer outcomes in a wide spectrum of surgeries but the specific effects of depression in patients undergoing cervical spine surgery are unknown. This study aimed to evaluate the prevalence and impact of pre-surgical clinical depression on pain and other outcomes after surgery for cervical degenerative disc disease using a national representative database. Data of patients with cervical myelopathy and radiculopathy were extracted from the 2005–2014 US Nationwide Inpatient Sample (NIS) database. Included patients underwent anterior discectomy and fusion (ACDF). Acute or chronic post-surgical pain, postoperative complications, unfavorable discharge, length of stay (LOS) and hospital costs were evaluated. Totally 215,684 patients were included. Pre-surgical depression was found in 29,889 (13.86%) patients, with a prevalence nearly doubled during 2005–2014 in the US. Depression was independently associated with acute or chronic post-surgical pain (aOR: 1.432), unfavorable discharge (aOR: 1.311), prolonged LOS (aOR: 1.152), any complication (aOR: 1.232), respiratory complications/pneumonia (aOR: 1.153), dysphagia (aOR: 1.105), bleeding (aOR: 1.085), infection/sepsis (aOR: 1.529), and higher hospital costs (beta: 1080.640) compared to non-depression. No significant risk of delirium or venous thrombotic events was observed in patients with depression as compared to non-depression. Among patients receiving primary surgery, depression was independently associated with prolonged LOS (aOR: 1.150), any complication (aOR:1.233) and postoperative pain (aOR:1.927). In revision surgery, no significant associations were found for prolonged LOS, any complication or pain. In conclusion, in the US patients undergoing ACDF, pre-surgical clinical depression predicts post-surgical acute or chronic pain, a slightly prolonged LOS and the presence of any complication. Awareness of these associations may help clinicians stratify risk preoperatively and optimize patient care.
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Affiliation(s)
- Jiang Chen
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Yu Li
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Gui-Hua Tian
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Rui-Jin Qiu
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Qian Zhao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-Shi Di
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiao-Mei Yuan
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shui-Wen Long
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Ran
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu-Song Jia
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Cai Shang
- Hunan University of Chinese Medicine, Changsha, Hunan, China
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Pulik Ł, Podgajny M, Kaczyński W, Sarzyńska S, Łęgosz P. The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty. Indian J Orthop 2021; 55:823-838. [PMID: 34188772 PMCID: PMC8192606 DOI: 10.1007/s43465-021-00357-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION It is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient's comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used. METHODS The article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient's comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient's physical functioning was performed by two independent researchers. RESULTS The initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies. CONCLUSION The comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.
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Affiliation(s)
- Łukasz Pulik
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
| | - Michał Podgajny
- Student Scientific Association of Reconstructive and Oncology Orthopedics of the Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Wiktor Kaczyński
- Student Scientific Association of Reconstructive and Oncology Orthopedics of the Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Sarzyńska
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
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Hernandez NM, Vakharia RM, Mont MA, Roche MW, Seyler TM. Antipsychotic Use Is Associated With Longer In-hospital Lengths of Stay and Higher Rates of Venous Thromboembolism and Costs of Care After Primary Total Knee Arthroplasty. J Am Acad Orthop Surg 2021; 29:e675-e680. [PMID: 34135297 DOI: 10.5435/jaaos-d-20-00726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/16/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Studies have shown that antipsychotic medication use may lead to venous thromboembolisms (VTEs); however, this association has not been demonstrated in patients undergoing primary total knee arthroplasty (TKA). Therefore, the purpose of this study was to investigate whether patients taking antipsychotic medications at the time of their primary TKA have higher rates of in-hospital lengths of stay (LOS), VTEs, and costs of care. METHODS Patients taking antipsychotic medications were identified and matched to a cohort in a 1:5 ratio by age, sex, and medical comorbidities. Patients who had a history of VTEs or hypercoagulable states before their TKA were excluded. The query resulted in 439,579 patients within the study (n = 73,285) and matching cohorts (n = 366,294). Outcomes analyzed included rates of in-hospital LOS, VTEs, and costs of care. A P value less than 0.01 was considered statistically significant. RESULTS We found statistically significant longer in-hospital LOS for patients taking antipsychotic medications (3.27 versus 3.02 days, P < 0.0001). Study patients were also found to have a higher incidence and odds ratio of VTEs (2.37 versus 1.04%; odds ratio: 1.86, 95% confidence interval: 1.75-1.97, P < 0.0001). Ninety-day costs of care were also significantly higher in the study cohort ($17,332.70 versus $15,975.00, P < 0.0001). CONCLUSION After adjusting for confounders, patients taking antipsychotic medication were found to have higher rates of in-hospital LOS, VTEs, and costs of care. The study can be used by orthopaedic surgeons to counsel patients taking these medications concerning the potential complications after their procedure.
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Affiliation(s)
- Nicholas M Hernandez
- From the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Hernandez), Maimonides Medical Center, New York, NY (Vakharia), the Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY (Mont), Orthopaedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, FL (Roche), and the Department of Orthopaedic Surgery, Duke University, Durham, NC (Seyler)
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Seagrave KG, Lewin AM, Harris IA, Badge H, Naylor J. Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:2309499021992605. [PMID: 33596736 DOI: 10.1177/2309499021992605] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. METHODS A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. RESULTS 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a "much better" global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. CONCLUSION After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.
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Affiliation(s)
- Kurt G Seagrave
- 4334The University of Sydney School of Medicine, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Adriane M Lewin
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen Badge
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,276979Australian Catholic University, North Sydney, New South Wales, Australia
| | - Justine Naylor
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South West Sydney Clinical School, 7800University of New South Wales, Sydney, New South Wales, Australia.,South Western Sydney Local Health District, Sydney, New South Wales, Australia
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Ng JPH, Ho SWL, Yam MGJ, Tan TL. Functional Outcomes of Patients with Schizophrenia After Hip Fracture Surgery: A 1-Year Follow-up from an Institutional Hip Fracture Registry. J Bone Joint Surg Am 2021; 103:786-794. [PMID: 33770021 DOI: 10.2106/jbjs.20.01652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Schizophrenia impairs a patient's self-care abilities, which are crucial after a hip fracture. Studies on the outcomes of patients with schizophrenia after a hip fracture are dated. This study aims to investigate the complication rates, 1-year mortality, and functional outcomes of surgically managed hip fractures in elderly patients with schizophrenia. METHODS This is a retrospective, single-institution cohort study based on a prospectively maintained registry of patients with hip fracture. In this study, 3,056 patients who were ≥60 years of age were treated under a geriatric-orthopaedic hip fracture pathway from January 2014 to December 2018. Baseline demographic characteristics and the Modified Barthel Index (MBI) scores were obtained at admission and at 6 months and 1 year after the fracture. Complications from the fracture and the surgical procedure were recorded during a minimum follow-up period of 2 years. A matching process (based on age, sex, and the MBI at admission) of up to 6 patients without schizophrenia per 1 patient with schizophrenia was utilized to increase power. Differences in perioperative, 6-month, and 1-year outcomes were compared for significance among surgically managed patients with schizophrenia and patients without schizophrenia. RESULTS Thirty-eight patients with schizophrenia were compared with 170 geriatric patients without schizophrenia who underwent a surgical procedure for a hip fracture. Patients with schizophrenia were more likely to be institutionalized postoperatively (26.3% compared with 4.7%; p < 0.001). Patients with schizophrenia had poorer MBI scores at 12 months (76 compared with 90 points; p = 0.006). The 1-year mortality rate was comparable (p = 0.29) between patients with schizophrenia (5.7%) and those without schizophrenia (2.4%). Similar trends in MBI were observed in the conservatively managed group of patients. CONCLUSIONS There was no increase in postoperative complications after a surgical procedure for a hip fracture in elderly patients with schizophrenia. The 1-year mortality after a surgical procedure for hip fracture is similar in both patients with schizophrenia and those without schizophrenia. Patients with schizophrenia and hip fracture who were surgically managed had poorer 1-year functional outcomes compared with patients without schizophrenia matched for age, sex, and MBI at admission. This information will be useful in shared decision-making discussions with patients and families. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Shinjo D, Tachimori H, Maruyama-Sakurai K, Fujimori K, Inoue N, Fushimi K. Consultation-liaison psychiatry in Japan: a nationwide retrospective observational study. BMC Psychiatry 2021; 21:235. [PMID: 33952238 PMCID: PMC8097923 DOI: 10.1186/s12888-021-03241-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consultation-liaison psychiatry (CLP)-professional psychiatric care provided to coordinate with surgical or medical treatment of inpatients with psychiatric disorders-was included in universal health coverage in Japan in 2012. Despite evidence of benefits of CLP, basic data and geographic distribution information regarding CLP at the national level remain unclear. This study aimed to 1) identify the geographic disparity of CLP in Japan and 2) investigate the association between number of consultations per CLP patient and region. METHODS We retrospectively analyzed anonymized data retrieved from the Japanese administrative inpatient database regarding inpatients who were provided CLP between April 2012 and March 2017. Demographic characteristics were summarized and geographic disparity by prefecture was visualized for fiscal years 2012 and 2016; we also summarized the data according to region. Multivariate linear regression analysis was used to investigate association between the number of consultations per CLP patient and region after adjusting for covariates. RESULTS Data from a total of 46,171 patients who received 138,866 CLP services were included. Results revealed more patients aged 75-84 years received CLPs than any other age group (29.7%) and the overall male/female ratio was 53:47 in 2016. In 2012 and 2016, 24.2 and 30.7% of CLP patients, respectively, were transferred to other hospitals; 9.7 and 8.8%, respectively, discharged due to the death. CLP services were provided in 14 prefectures in 2012 and 33 by 2016; 14 prefectures had no available CLP services. After adjusting for covariates, Tohoku (β = - 0.220, p < 0.034), Chugoku (β = - 0.160, p < 0.026), and Shikoku (β = - 0.555, p < 0.001) had a significant negative correlation with the number of consultations per CLP patient compared with Hokkaido region (an adjusted R square (R2) = 0.274). CONCLUSIONS Our study clarified the characteristics of patients in Japan who received CLPs and the geographic disparity in CLP services. Although 5 years had passed since CLP was introduced, the results imply wide availability of CLP nationally. The analysis data provided may inform future policies to improve CLP services.
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Affiliation(s)
- Daisuke Shinjo
- grid.63906.3a0000 0004 0377 2305Department of Information Technology and Management, The National Center of Child Health and Development, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Japan
| | - Hisateru Tachimori
- grid.416859.70000 0000 9832 2227Department of Mental Health Policy and Evaluation, National Institute of Mental Health, The National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Institute for Global Health Policy Research, The National Center for Global Health and Medicine, Tokyo, Japan
| | - Keiko Maruyama-Sakurai
- grid.416859.70000 0000 9832 2227Department of Mental Health Policy and Evaluation, National Institute of Mental Health, The National Center of Neurology and Psychiatry, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Institute for Global Health Policy Research, The National Center for Global Health and Medicine, Tokyo, Japan
| | - Kenji Fujimori
- grid.69566.3a0000 0001 2248 6943Department of Health Administration and Policy, Tohoku University, Sendai, Japan
| | - Norihiko Inoue
- grid.63906.3a0000 0004 0377 2305Department of Information Technology and Management, The National Center of Child Health and Development, Tokyo, Japan ,grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519 Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1138519, Japan.
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Kooner S, Kubik J, Mahdavi S, Piroozfar SG, Khong H, Mohan K, Batuyong E, Sharma R. Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty? SAGE Open Med 2021; 9:20503121211012254. [PMID: 33996082 PMCID: PMC8107666 DOI: 10.1177/20503121211012254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Sahil Kooner
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jeremy Kubik
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Saboura Mahdavi
- Department of Surgery, University of Calgary, Calgary, AB, Canada.,Alberta Hip and Knee Clinic, Calgary, AB, Canada
| | - Sophie Ghashang Piroozfar
- Alberta Hip and Knee Clinic, Calgary, AB, Canada.,Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - Hoa Khong
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - Kanwal Mohan
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Rajrishi Sharma
- Department of Surgery, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Alberta Hip and Knee Clinic, Calgary, AB, Canada
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