La Ashley, Nadarajah Vidushan, Jauregui Julio J, Shield William P, Medina Shaun H, Dubina Andrew G, Meredith Sean J, Packer Jonathan D, Henn R Frank
Department of Orthopaedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
J Clin Orthop Trauma. 2020 Feb;11(Suppl 1):S164-S170. doi: 10.1016/j.jcot.2019.08.009. Epub 2019 Aug 12.
Preoperative depression and anxiety in patients undergoing surgery have been shown to be associated with increased postoperative complications, decreased functional improvement, and long-term dissatisfaction. The purpose of this prospective study was to measure the relationship between a diagnosis of depression or anxiety and Patient-Reported Outcomes Measurement Information System (PROMIS) domains, as well as determine which preoperative factors are associated with depression or anxiety in patients undergoing knee surgery. We hypothesized that preoperative depression and/or anxiety would be associated with worse preoperative pain, function, and general health status.
Three-hundred and eighty-six patients undergoing knee surgery between 2015 and 2017 were administered health-related quality of life measures preoperatively, and their medical records were reviewed for relevant medical history. A propensity matched analysis was performed to determine clinical factors independently associated with preoperative depression and/or anxiety.
The overall study population consisted of 216 males and 170 females, with a mean age of 39.4 ± 16.2 years. From this overall cohort, 43 (11.1%) patients had a positive preoperative diagnosis of depression and/or anxiety. After controlling for covariate imbalances, preoperative depression/anxiety was independently associated with PROMIS Anxiety (p = 0.018), PROMIS Depression (p < 0.019), and Tegner pre-injury (p = 0.013) scores. Regression analysis also determined that preoperative depression/anxiety was independently associated with arthroscopic anterior cruciate ligament reconstruction (ACLR) (p = 0.004), total knee arthroplasty (TKA) (p = 0.019), and uni-compartmental knee arthroplasty (p < 0.05).
The results support our hypothesis that preoperative depression/anxiety is associated with worse preoperative pain, function, and general health status. Furthermore, PROMIS Anxiety and Depression tools offer a reliable means of measuring psychological distress in the orthopaedic knee population. Similar to other studies, we also noted psychological comorbidity to be independently associated with ACLR and TKA.
手术患者术前的抑郁和焦虑已被证明与术后并发症增加、功能改善减少以及长期不满意有关。这项前瞻性研究的目的是测量抑郁或焦虑诊断与患者报告结局测量信息系统（PROMIS）各领域之间的关系，并确定哪些术前因素与膝关节手术患者的抑郁或焦虑相关。我们假设术前抑郁和/或焦虑会与更差的术前疼痛、功能和总体健康状况相关。
对2015年至2017年间接受膝关节手术的386例患者术前进行了健康相关生活质量测量，并查阅他们的病历以了解相关病史。进行倾向匹配分析以确定与术前抑郁和/或焦虑独立相关的临床因素。
整个研究人群包括216名男性和170名女性，平均年龄为39.4±16.2岁。在这个总体队列中，43例（11.1%）患者术前抑郁和/或焦虑诊断呈阳性。在控制协变量不平衡后，术前抑郁/焦虑与PROMIS焦虑（p = 0.018）、PROMIS抑郁（p < 0.019）以及损伤前Tegner评分（p = 0.013）独立相关。回归分析还确定术前抑郁/焦虑与关节镜下前交叉韧带重建（ACLR）（p = 0.004）、全膝关节置换术（TKA）（p = 0.019）和单髁膝关节置换术（p < 0.05）独立相关。
结果支持我们的假设，即术前抑郁/焦虑与更差的术前疼痛、功能和总体健康状况相关。此外，PROMIS焦虑和抑郁工具为测量骨科膝关节人群的心理困扰提供了一种可靠的方法。与其他研究类似，我们还注意到心理合并症与ACLR和TKA独立相关。
