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The Effect of Psychiatric Diagnosis and Psychotropic Medication on Outcomes Following Total Hip and Total Knee Arthroplasty.

Authors
  • Stone, Andrea H1
  • MacDonald, James H2
  • King, Paul J2
  • 1 Department of Surgical Research, Anne Arundel Medical Center, Annapolis, MD.
  • 2 Center for Joint Replacement, Anne Arundel Medical Center, Annapolis, MD.
Type
Published Article
Journal
The Journal of arthroplasty
Publication Date
Sep 01, 2019
Volume
34
Issue
9
Pages
1918–1921
Identifiers
DOI: 10.1016/j.arth.2019.04.064
PMID: 31130445
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Nearly 20% of the US adult population lives with mental illness, and less than 50% of these receive treatment. Preoperative mental health may affect postoperative outcomes in patients undergoing total joint arthroplasty (TJA), yet is rarely addressed; poor outcomes increase the cost of care and burden on the healthcare system. This study examines the influence of patients with psychiatric diagnosis (PD) and taking psychotropic medication (PM) on emergency room visits, readmissions, and discharge disposition following TJA. Single institution retrospective analysis of a consecutive series of 3020 primary TJA performed between January 2017 and June 2018. Chi-squared, t-tests, and analysis of variance were used to quantify differences between groups. Nine hundred seventy-six (32.3%) patients had a PD, most had depression (10.1%), anxiety (8.6%), or both (8.4%); 808 (26.8%) patients were on PM. Patients with PD were more likely to experience emergency room visits (6.3% vs 10.0%, P = .034) and skilled nursing facility discharge (11.6% vs 17.9%, P = .005). Patients taking PM were more likely to experience skilled nursing facility discharge (12.4 vs 17.1, P = .047); those taking >2 PM had the highest rate (21.6%). Patients with PD on or off PM may experience increased healthcare utilization in the postoperative period. Increased patient education and support may reduce these discrepancies. PD is not a deterrent for TJA, but targeted interventions should be developed to provide additional support where needed and avoid unnecessary utilization of resources. Copyright © 2019 Elsevier Inc. All rights reserved.

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