TY - JOUR
T1 - The Role of Psychiatric Diagnoses for Outcome After Hip and Knee Arthroplasty
AU - Gylvin, Silas H.
AU - Jørgensen, Christoffer C.
AU - Fink-Jensen, Anders
AU - Gislason, Gunnar H.
AU - Kehlet, Henrik
AU - Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group
A2 - Madsen, Frank
A2 - Hansen, Torben B
A2 - Husted, Henrik
A2 - Laursen, Mogens B.
A2 - Hansen, Lars T.
A2 - Kjærsgaard-Andersen, Per
A2 - Solgaard, Søren
PY - 2017
Y1 - 2017
N2 - Background Surgical patients receiving psychopharmacologic treatment have been associated with adverse outcomes in total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate whether a specific high-risk group of patients receiving psychopharmacologic treatment could be identified based upon a nationwide psychiatric diagnosis register. Methods From 7 different orthopedic centers, 8288 THA and TKA patients were included from January 2010 to November 2012 of which 943 (11.4%) received psychopharmacologic treatment. Patients receiving preoperative psychopharmacologic treatment were divided into 2 groups based on the presence or absence of a psychiatric diagnosis in a nationwide administrative database and analyzed with respect to length of hospital stay (LOS >4 days) and 30- and 90-day readmissions using multivariable logistic regression models. Results A total of 191 patients receiving psychopharmacologic treatment were registered with a psychiatric diagnosis while 752 patients received psychopharmacologic treatment without a registered psychiatric diagnosis. No significantly increased risk was found in patients with a preoperative registered psychiatric diagnosis compared to patients without, with regard to LOS >4 days (odds ratio [OR], 1.19; P =.51), 30-day readmission (OR, 0.56; P =.086), or 90-day readmission (OR, 0.81; P =.446), respectively. However, both groups had an increased risk of LOS >4 days and readmissions compared to a control population without psychopharmacologic treatment or any registered psychiatric diagnoses. Conclusion No further risk was found for psychopharmacologically treated THA/TKA patients with an additional hospital-related psychiatric diagnosis compared to patients without, suggesting that the psychopharmacologic treatment per se is an outcome risk factor independent of severity of the psychiatric disorder.
AB - Background Surgical patients receiving psychopharmacologic treatment have been associated with adverse outcomes in total hip and knee arthroplasty (THA and TKA). The purpose of this study was to investigate whether a specific high-risk group of patients receiving psychopharmacologic treatment could be identified based upon a nationwide psychiatric diagnosis register. Methods From 7 different orthopedic centers, 8288 THA and TKA patients were included from January 2010 to November 2012 of which 943 (11.4%) received psychopharmacologic treatment. Patients receiving preoperative psychopharmacologic treatment were divided into 2 groups based on the presence or absence of a psychiatric diagnosis in a nationwide administrative database and analyzed with respect to length of hospital stay (LOS >4 days) and 30- and 90-day readmissions using multivariable logistic regression models. Results A total of 191 patients receiving psychopharmacologic treatment were registered with a psychiatric diagnosis while 752 patients received psychopharmacologic treatment without a registered psychiatric diagnosis. No significantly increased risk was found in patients with a preoperative registered psychiatric diagnosis compared to patients without, with regard to LOS >4 days (odds ratio [OR], 1.19; P =.51), 30-day readmission (OR, 0.56; P =.086), or 90-day readmission (OR, 0.81; P =.446), respectively. However, both groups had an increased risk of LOS >4 days and readmissions compared to a control population without psychopharmacologic treatment or any registered psychiatric diagnoses. Conclusion No further risk was found for psychopharmacologically treated THA/TKA patients with an additional hospital-related psychiatric diagnosis compared to patients without, suggesting that the psychopharmacologic treatment per se is an outcome risk factor independent of severity of the psychiatric disorder.
KW - hip and knee arthroplasty
KW - perioperative management
KW - preoperative risk management
KW - psychiatric disease
KW - psychopharmacology
KW - surgical risk
U2 - 10.1016/j.arth.2017.06.051
DO - 10.1016/j.arth.2017.06.051
M3 - Journal article
AN - SCOPUS:85027148754
SN - 0883-5403
VL - 32
SP - 3611
EP - 3615
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 12
ER -