抑郁症患者全关节置换术的结局：一项系统综述。
Outcomes of total joint arthroplasty in patients with depression: A systematic review.
作者信息
Vajapey Sravya P, McKeon John F, Krueger Chad A, Spitzer Andrew I
机构信息
Department of Orthopaedics, The Ohio State University Wexner Medical Center, USA.
Department of Orthopaedic Surgery, The Rothman Institute, USA.
出版信息
J Clin Orthop Trauma. 2021 May 3;18:187-198. doi: 10.1016/j.jcot.2021.04.028. eCollection 2021 Jul.
BACKGROUND
Depression has been implicated as a poor predictor of outcomes after total joint arthroplasty (TJA) of the lower extremity in some studies. We aimed to determine whether depression as a comorbidity affects the TJA outcomes and whether pain reduction associated with successful TJA alters depressive symptoms.
METHODS
A search of PUBMED was performed using keywords "depression", "arthroplasty", "depressive disorder", and "outcomes." All English studies published over the last ten years were considered for inclusion. Quantitative and qualitative analysis was then performed on the data.
RESULTS
Thirty articles met inclusion criteria (16 retrospective, 14 prospective). Three showed that depressed patients were at higher risk for readmission. Two reported that depressed patients had higher likelihood of non-home discharge after TJA compared to non-depressed patients. Four noted that depressed patients incur higher hospitalization costs than non-depressed patients. Ten suggest depression is a predictor of poor patient-reported outcome measures, pain, and satisfaction after TJA. Five suggested the gains depressed patients experience in functional outcome scores after TJA are similar to gains experienced by patients without depression. Another eight suggested that TJA improves not only function and pain but also depressive symptoms in patients with depression.
CONCLUSION
The results of this review show that depression increases the risk of persistent pain, dissatisfaction, and complications after TJA. Additionally, depressed patients may incur higher costs than non-depressed patients undergoing TJA and may have worse preoperative and postoperative patient reported outcome measures (PROMs). However, the gains in function that depressed patients experience after TJA are equivalent to gains experienced by non-depressed patients and depressed patients may experience improvement in their depressive symptoms after TJA. Patient selection for TJA is critical and counseling regarding increased risk for complications is crucial in depressed patients undergoing TJA.
背景
在一些研究中，抑郁症被认为是下肢全关节置换术（TJA）后预后的不良预测指标。我们旨在确定抑郁症作为一种合并症是否会影响TJA的预后，以及与成功的TJA相关的疼痛减轻是否会改变抑郁症状。
方法
使用关键词“抑郁症”“关节成形术”“抑郁症”和“预后”在PUBMED上进行检索。纳入过去十年发表的所有英文研究。然后对数据进行定量和定性分析。
结果
30篇文章符合纳入标准（16篇回顾性研究，14篇前瞻性研究）。3篇研究表明，抑郁症患者再次入院的风险更高。2篇报道称，与非抑郁症患者相比，抑郁症患者TJA后非回家出院的可能性更高。4篇指出，抑郁症患者的住院费用高于非抑郁症患者。10篇研究表明，抑郁症是患者报告的TJA后预后指标、疼痛和满意度较差的预测指标。5篇研究表明，抑郁症患者TJA后功能结局评分的改善与非抑郁症患者相似。另外8篇研究表明，TJA不仅改善了抑郁症患者的功能和疼痛，还改善了他们的抑郁症状。
结论
本综述结果表明，抑郁症会增加TJA后持续疼痛、不满和并发症的风险。此外，抑郁症患者的费用可能高于接受TJA的非抑郁症患者，并且术前和术后患者报告的预后指标（PROMs）可能更差。然而，抑郁症患者TJA后功能的改善与非抑郁症患者相当，并且抑郁症患者TJA后抑郁症状可能会有所改善。TJA的患者选择至关重要，对于接受TJA的抑郁症患者，关于并发症风险增加的咨询至关重要。
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