Psychiatric disorders increase complication rate after primary total knee arthroplasty

Klement, Mitchell R.; Nickel, Brian T.; Penrose, Colin T.; Bala, Abiram; Green, Cynthia L.; Wellman, Samuel S.; Bolognesi, Michael P.; Seyler, Thorsten M.

doi:10.1016/j.knee.2016.05.007

Cited by 71 publications

(59 citation statements)

References 32 publications

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“…Another concurrent study based on a separate database, the Nationwide Inpatient Sample (NIS), demonstrated that a preoperative diagnosis of depression was linked to a higher risk of postoperative medical complications including anemia, infection, and pulmonary embolism [OR for anemia 1.14 with CI 1.09-1.17, P < .001; OR for infection 1.33 with CI 1.21-1.41, P = .012; OR for PE 1.20 with CI 1.14-1.25, P = .005; Table 1] [15]. These findings were again corroborated by a single institution's retrospective review of approximately 2000 patients, where a preoperative diagnosis of depression or anxiety was independently associated with a statistically significant increase in the rate of postoperative medical complications after hip and knee arthroplasty from 15.5% in the cohort with no mental health disorders to 29% in the patients with depression or anxiety [P < .001, showed that patients with a diagnosis of depression, bipolar disorder, or schizophrenia had a twofold increase in the likelihood of knee extensor mechanism rupture, periprosthetic fracture, prosthetic join infection, and need for revision arthroplasty at minimum of 2-year follow-up [OR for extensor mechanism rupture 2.18 with CI 1.95-2.42, P < .001; OR for periprosthetic fracture 2.20 with CI 1.96-2.47, P < .001; OR for prosthetic joint infection 2.08 with CI 1.98-2.17, P < .001; OR for revision arthroplasty 2.01 with CI 1.88-2.15, P < .001; Table 1] [19].…”

Section: Mental Healthmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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Purpose of Review It is well established that certain patientspecific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. Recent Findings Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Summary Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.

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Section: Mental Healthmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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“…Studies have shown that patients with depression and other psychiatric disorders have an increased risk of adverse outcomes and readmission after total joint arthroplasty [39,40]. Klement et al found that patients with psychiatric disorders such as bipolar disorder, schizophrenia, and depression were more likely to be younger and more medically complex.…”

Section: Psychiatric Diseasementioning

confidence: 99%

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Sveom¹,

Otteman²,

Garvin³

2017

Curr Rev Musculoskelet Med

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Purpose of review Total joint arthroplasty (TJA) has had an increased demand over the recent years. It is a successful procedure, and there are relatively few complications, but there is a high overall cost. There is a push to increase the quality of care, lessen complications, and decrease cost by reducing readmissions. This article will discuss the risk factors that can contribute to the complication and readmission rates following TJA. Recent findings Several risk factors have been found to contribute to the complication and readmission rates following a TJA. It is important to understand these risk factors and mitigate them as much as possible in order to optimize the patient experience. There are risk factors that cannot be modified, and the treatment team as well as the patient should be made aware of these and account for them when making the decision whether to undergo elective primary TJA or not. In general, an increased number of risk factors is associated with increased complications and increased readmission rates. At our institution, we have used this knowledge to improve our outcomes and decrease costs. Summary It is important to be mindful of risk factors for poor outcomes prior to performing TJA. This allows for the optimization of patients prior to undergoing surgery. This can lead to improved outcomes at a lower cost.

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“…Quantitative designs have been used to assess patient satisfaction after TKA in previous studies [3,[6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], but to our knowledge no qualitative studies have examined patient´s experience of discontentment after TKA. The few studies addressing patient satisfaction have focused on the importance of patient education and information before and after surgery [23,[32][33][34][35][36][37].…”

Section: Introductionmentioning

confidence: 99%

Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

Mahdi

Svantesson

Wretenberg

et al. 2020

Preprint

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Background Total knee arthroplasty is a common procedure with generally good results. However, there are still patients who are discontented without known explanation. Contentment and discontentment have previously been captured by quantitative designs, but there is a lack of qualitative studies regarding these patients’ experiences. Qualitative knowledge might be useful in creating strategies to decrease the discontentment rate. Methods Of the 348 patients who responded to a letter asking if they were contented or discontented with their surgery, 61 (18%) reported discontentment. After excluding patients with documented complications and those who declined to participate, semi-structured interviews were conducted with 44 patients. The interviews were analyzed according to qualitative content analysis. The purpose was to describe patients’ experiences of discontentment one year after total knee arthroplasty. Results The patients experienced unfulfilled expectations and needs regarding unresolved and new problems, limited independence, and need for buttresses. They were bothered by pain and stiffness, and worried that changes were complications as a result of surgery. They described inability to perform daily activities and valued activities. They also felt a need for buttresses, and a lack of respect and continuity, support from health care, and information adapted to their needs. Conclusion Patient expectation seems to be the major contributing factor in patient discontentment after knee replacement surgery. This qualitative study sheds light on the meaning of unfulfilled expectations, in contrast to previous quantitative studies. The elements of unfulfilled expectations need to be dealt with both on the individual staff level and on the organizational level. For instance, increased continuity of healthcare staff and facilities may help to improve patient contentment after surgery.

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Psychiatric disorders increase complication rate after primary total knee arthroplasty

Cited by 71 publications

References 32 publications

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Patients’ experiences of discontentment one year after total knee arthroplasty- A qualitative study

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