title: The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the National Hospital Discharge Survey database.
abstract: Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P<0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P<0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P<0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P<0.001).
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Miami, Florida.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Miami, Florida.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Best
authors.affiliation: Cleveland Clinic Department of Orthopaedic Surgery, Cleveland, Ohio.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Cleveland Clinic Department of Orthopaedic Surgery, Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: dementia; depression: anxiety; schizophrenia; total hip arthroplasty; total knee arthroplasty