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

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.