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Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

ABSTRACT: Background:The aim of this prospective cohort study was to determine the effect of preoperative mental health status on functional outcome 1 year after total hip arthroplasty (THA). Methods:Data were collected for 677 patients from a randomized controlled trial in Alberta who received primary THA between April 2005 and June 2006 (sex, age, body mass index [BMI], comorbidities, back pain and need for another lower limb arthroplasty procedure within 1 yr after surgery). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and 36-Item Short Form Health Survey (SF-36) mental health component were administered before surgery and 1 year after. We conducted multiple linear regression to determine the effect of mental health on the WOMAC score at 1 year. Results:The mean WOMAC and SF-36 mental health scores were significantly increased at 1 year (p < 0.001 and p = 0.01, respectively). There was a strong correlation between improvement in WOMAC score at 1 year and presurgery SF-36 mental health score (0.13, 95% confidence interval [CI] 0.06 to 0.2). Age (–0.34, 95% CI –0.45 to –0.24), obesity (–2.9, 95% CI –5.32 to –0.4), back pain (–5.75, 95% CI –8.04 to –3.46) and awaiting another joint arthroplasty operation (–6.18, 95% CI –8.9 to –3.47) had a negative impact on the WOMAC score. Conclusion:There was a strong correlation between presurgery mental health and the resolution of pain and improved functioning 1 year after THA. We recommend that patients receive appropriate counselling and, where appropriate, medical therapy before THA.

SUBMITTER: Jaiswal P

PROVIDER: S-EPMC7006349 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

Jaiswal Parag P Railton Pam P Khong Hoa H Smith Christopher C Powell James J

Canadian journal of surgery. Journal canadien de chirurgie 20191001 5

<h4>Background</h4>The aim of this prospective cohort study was to determine the effect of preoperative mental health status on functional outcome 1 year after total hip arthroplasty (THA).<h4>Methods</h4>Data were collected for 677 patients from a randomized controlled trial in Alberta who received primary THA between April 2005 and June 2006 (sex, age, body mass index [BMI], comorbidities, back pain and need for another lower limb arthroplasty procedure within 1 yr after surgery). The Western ...[more]

PMID: 31550091

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Project description:BackgroundPeriprosthetic fractures are a devastating complication of total hip arthroplasty (THA) and are associated with significantly higher mortality rates in the postoperative period. Given the strain that periprosthetic fractures place on the patient as well as the healthcare system, identifying and optimizing medical comorbidities is essential in reducing complications and improving outcomes.MethodsAll THA with primary indications of osteoarthritis from 2007 to 2020 were queried from the National Surgical Quality Improvement Program database. Demographic data, preoperative laboratory values, medical comorbidities, hospital course, and acute complications were collected and compared between patients with and without readmission for a periprosthetic fracture. A multivariate logistic regression analysis was performed to determine associated independent risk factors for periprosthetic fractures after index THA.ResultsThe analysis included 275,107 patients, of which 2539 patients were readmitted for periprosthetic fractures. Patients with postoperative fractures were more likely to be older (>65 years), females, BMI >40, and increased medical comorbidities. Preoperative hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rates were independent risk factors for sustaining a periprosthetic fracture and readmission within 30 days. Modifiable patient-related factors of concurrent smoking and chronic steroid use at the time of index THA were also independent risk factors for periprosthetic fractures. Inpatient metrics of longer length of stay, operative time, and discharge to rehab predicted postarthroplasty fracture risk. Readmitted fracture patients subsequently had increased risks of developing a surgical site infection, urinary tract infection, and requiring blood transfusions.ConclusionsPatients with hypoalbuminemia, hyponatremia, and abnormal estimated glomerular filtration rate are at increased risk for sustaining periprosthetic fractures after THA. Preoperative optimization with close monitoring of metabolic markers and modifiable risk factors may help not only prevent acute periprosthetic fractures but also associated infection and bleeding risk with fracture readmission.

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Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

Publications

Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

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