Effects of psychiatric comorbidity on perioperative outcomes in primary total elbow arthroplasty

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2025-03-07 DOI:10.1053/j.sart.2025.01.010

Lawrence C. Vanderham MS, PA , Alexander S. Guareschi MD , John W. Moore BS , Richard J. Friedman MD, FRCSC , Brandon L. Rogalski MD , Josef K. Eichinger MD

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引用次数: 0

Abstract

Background

Current literature consistently demonstrates the negative impact of mental health disorder (MHD) on orthopedic perioperative outcomes in arthroplasty of the hip, knee, and shoulder. To date, minimal literature exists investigating the effects of MHD on total elbow arthroplasty (TEA) outcomes. The purpose of this study is to evaluate the influence of MHD on perioperative complications, revision, and readmission rates, length of stay, and disposition in patients undergoing primary TEA.

Methods

The Nationwide Readmissions Database was queried and 5742 subjects undergoing primary TEA were identified, between 2015 and 2020. Two cohorts, with and without MHD were formed. Significant variables and outcomes were identified using bivariate analysis. Variables identified as significant were placed in multivariate analysis to identify independent predictors. Continuous variables between the two cohorts were analyzed with linear regression.

Results

Patients with a MHD were found to have higher rates of several medical and surgical complications including respiratory complications (0.6% vs. 0.1%; odds ratio [OR] 4.4 [95% confidence interval (CI) 1.6, 12], P = .002, wound dehiscence (0.8% vs. 0.1%; OR 11 [95% CI 3.0, 37], P < .001), and prosthetic loosening (11% vs. 6.4%; OR 1.7 [95% CI 1.4, 2.1], P < .001). A multivariate analysis identified MHD as an independent predictor of readmission (OR 1.3 [95% CI 1.2-1.5], P < .001) and revision (OR 1.3 [95% CI 1.1-1.6], P < .001) within 180 days of TEA.

Conclusion

Patients with a pre-existing MHD undergoing primary TEA are at increased risk for perioperative comorbidity. Careful consideration for surgery and potential risk mitigation should be considered in this at-risk population.

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精神合并症对初次全肘关节置换术围手术期疗效的影响

背景：目前的文献一致表明，心理健康障碍（MHD）对髋关节、膝关节和肩部关节置换术围手术期结果的负面影响。迄今为止，很少有文献研究MHD对全肘关节置换术（TEA）结果的影响。本研究的目的是评估MHD对原发性TEA患者围手术期并发症、翻修、再入院率、住院时间和处置的影响。方法查询全国再入院数据库，并在2015年至2020年期间确定5742名接受初级TEA的受试者。两个队列，有和没有MHD组成。使用双变量分析确定重要变量和结果。确定为重要的变量被放置在多变量分析中，以确定独立的预测因子。用线性回归分析两个队列之间的连续变量。结果MHD患者的几种内科和外科并发症发生率较高，包括呼吸系统并发症(0.6% vs. 0.1%；优势比[OR] 4.4[95%可信区间（CI） 1.6, 12], P = .002，伤口裂开(0.8% vs. 0.1%；OR 11 [95% CI 3.0, 37], P <；.001)，假体松动(11% vs. 6.4%；OR 1.7 [95% CI 1.4, 2.1], P <；措施)。一项多变量分析发现MHD是再入院的独立预测因子(OR 1.3 [95% CI 1.2-1.5], P <；.001)和修订(OR 1.3 [95% CI 1.1-1.6], P <；.001)在TEA后180天内。结论：既往MHD患者行原发性TEA手术围手术期合并症的风险增加。在这一高危人群中，应仔细考虑手术和潜在的风险缓解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in Arthroplasty Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

104

期刊介绍： Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.