Increased Complications for Schizophrenia and Bipolar Disorder Patients Undergoing Total Joint Arthroplasty

Kheir, Michael M.; Kheir, You Na P.; Tan, Timothy L.; Ackerman, Colin T.; Rondon, Alexander J.; Chen, Antonia F.

doi:10.1016/j.arth.2017.12.006

Cited by 28 publications

(15 citation statements)

References 31 publications

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“…Table 4 describes the 15 studies (20 analyses) included in the review that assessed the impact of SMI on the use of emergency care [ 20 , 23 , 29 , 31 , 32 , 34 , 39 , 42 , 44 , 45 , 70 , 76 , 84 – 86 ]. In 18 out of 20 of the analyses, SMI was associated with increased use of emergency departments.…”

Section: Resultsmentioning

confidence: 99%

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

et al. 2020

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Background Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. Methods and findings PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies ( n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21–2.80, p = 0.005, I 2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36–0.83, p < 0.001, I 2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28–1.47, p < 0.001, I 2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41–2.76, p < 0.001, I 2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. Conclusions In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.

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Section: Resultsmentioning

confidence: 99%

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

et al. 2020

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“…A number of studies have been published on cerebral dysfunction (i.e., a state of confusion, history of excessive alcohol consumption, Parkinson's disease, or neuromuscular disorders) and the risk of dislocation following THA (7,29,30). Several analyses have been performed on various patient characteristics (e.g., age, sex, height, weight, pre-operative diagnosis and cerebral dysfunction) and the rate of dislocation; the only variable associated with a higher dislocation rate was found to be cerebral dysfunction (7).…”

Section: Incidence Of Dislocation Following Total Hip Arthroplasty (Tmentioning

confidence: 99%

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Xiao

Xue

2019

Exp Ther Med

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The second most common complication following total hip arthroplasty (THA) is dislocation. The majority of dislocations occur early in the post-operative period and are due to either patient-associated or surgical factors. The patient-associated factors that have been implicated as causes of post-operative dislocation include previous surgery, lumbar spine fusion surgery and/or neurological impairment. The surgical factors include surgical approach, component orientation and prosthetic and/or bony impingement. In order to delineate the cause of the hip instability a thorough history and physical and a radiographic assessment (possibly including advanced imaging) needs to be performed. Approximately two thirds of cases are successfully treated; one third of cases will require surgical treatment (e.g., revision arthroplasty (including constrained liners, the use of elevated rim liners and dual mobility implants or trochanteric advancement). In this review, we discuss the causes leading to dislocation following THA and evaluate the different treatment options available.

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“…Severe mental illness was defined as a combination of any of the following diagnoses including schizophrenia, bipolar disorder, and other psychotic disorders based on prior literature that suggested these disorders predispose patients to greater risk of adverse events following spine surgery. 2,[13][14][15][16][17][18]…”

Section: Study Populationmentioning

confidence: 99%

Presence and Severity of Mental Illness Is Associated With Increased Risk of Postoperative Emergency Visits, Readmission, and Reoperation Following Outpatient ACDF: A National Database Analysis

Kamalapathy

Wang

Puvanesarajah

et al. 2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: The purpose was to compare rates of postoperative ED visits, readmission, and reoperation between patients with and without preexisting mental illness undergoing outpatient anterior cervical discectomy and fusion (ACDF). Methods: A retrospective review of the Mariner Database was conducted on patients who underwent ACDF between 2010 and 2017. Exclusion criteria included same day revision surgery and patients with a history of spine infection, trauma, or neoplasm. Patients were grouped into 3 categories: those with existing history of anxiety and/or depression, those with severe mental illness, and those without any history of mental illness. Severe mental illness was defined as a combination of diagnosis including schizophrenia, bipolar disorder, and/or psychotic disorder. Outcome measures were analyzed by comparing groups using multivariate logistic regression. Significance was set at P < 0.05. Results: Patients with anxiety/depression and patients with severe mental illness both had significantly increased risk of ED visits and readmission at 30-day and 90-day intervals. Compared to patients without mental illness, patients with severe mental illness (OR 1.93, P < 0.001) had significantly increased rates of reoperation at 90-days and 1-years postoperatively. Patients with anxiety/depression did not have increased rates of reoperation relative to patients without anxiety/depression at any time interval ( P > 0.05). Conclusion: Anxiety/depression as well as more severe psychiatric disease such as Schizophrenia and Bipolar disorder were significantly associated with increased healthcare utilization following outpatient ACDF. Patients with preexisting mental illness undergoing outpatient ACDF should be carefully evaluated preoperatively and closely followed postoperatively to reduce risk of adverse events.

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Increased Complications for Schizophrenia and Bipolar Disorder Patients Undergoing Total Joint Arthroplasty

Cited by 28 publications

References 31 publications

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

Causes of and treatment options for dislocation following total hip arthroplasty (Review)

Presence and Severity of Mental Illness Is Associated With Increased Risk of Postoperative Emergency Visits, Readmission, and Reoperation Following Outpatient ACDF: A National Database Analysis

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