Department of Orthopaedic Surgery, Emory University, Atlanta, GA.
J Arthroplasty. 2021 Mar;36(3):1120-1125. doi: 10.1016/j.arth.2020.10.009. Epub 2020 Oct 16.
Depression is known to be a risk factor for complication following primary total hip arthroplasty (THA), but little is known about new-onset depression (NOD) following THA. The purpose of this study is to determine the incidence of NOD and identify risk factors for its occurrence after THA.
This is a retrospective cohort study of the Truven MarketScan database. Patients undergoing primary THA were identified and separated into cohorts based on the presence or not of NOD. Patients with preoperative depression or a diagnosis of fracture were excluded. Patient demographic and comorbid data were queried, and postoperative complications were collected. Univariate and multivariate regression analysis was then performed to assess the association of NOD with patient-specific factors and postoperative complications.
In total, 111,838 patients undergoing THA were identified and 2517 (2.25%) patients had NOD in the first postoperative year. Multivariate analysis demonstrated that preoperative opioid use, female gender, higher Elixhauser comorbidity index, preoperative anxiety disorder, drug or alcohol use disorder, and preoperative smoking were associated with the occurrence of NOD (P ≤ .001). The following postoperative complications were associated with increased odds of NOD: prosthetic joint infection (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.42-2.34, P < .001), aseptic revision surgery (OR 1.47, 95% CI 1.06-2.04, P = .019), periprosthetic fracture (OR 1.72, 95% CI 1.13-2.61, P = .01), and non-home discharge (OR 1.59, 95% CI 1.42-1.77, P < .001).
NOD is common following THA and there are multiple patient-specific factors and postoperative complications which increase the odds of its occurrence. Providers should use this information to identify at-risk patients so that pre-emptive prevention strategies may be employed.
抑郁症是初次全髋关节置换术（THA）后发生并发症的已知风险因素，但对 THA 后新发抑郁症（NOD）知之甚少。本研究的目的是确定 NOD 的发生率，并确定 THA 后发生 NOD 的危险因素。
这是对 Truven MarketScan 数据库的回顾性队列研究。确定接受初次 THA 的患者，并根据是否存在 NOD 将其分为队列。排除术前患有抑郁症或骨折诊断的患者。查询患者的人口统计学和合并症数据，并收集术后并发症。然后进行单变量和多变量回归分析，以评估 NOD 与患者特定因素和术后并发症的关联。
共确定了 111838 例接受 THA 的患者，其中 2517 例（2.25%）患者在术后第一年出现 NOD。多变量分析表明，术前使用阿片类药物、女性、更高的 Elixhauser 合并症指数、术前焦虑障碍、药物或酒精使用障碍以及术前吸烟与 NOD 的发生相关（P≤.001）。以下术后并发症与 NOD 发生的几率增加相关：人工关节感染（比值比 [OR] 1.82，95%置信区间 [CI] 1.42-2.34，P<.001）、无菌翻修手术（OR 1.47，95% CI 1.06-2.04，P=.019）、假体周围骨折（OR 1.72，95% CI 1.13-2.61，P=.01）和非家庭出院（OR 1.59，95% CI 1.42-1.77，P<.001）。
THA 后 NOD 很常见，有多个患者特定因素和术后并发症会增加其发生的几率。提供者应利用这些信息来识别有风险的患者，以便可以采用预防策略。
