Knapp Paul, Layson James T, Mohammad Waleed, Pizzimenti Natalie, Markel David C
Section of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA.
Ascension-Providence Orthopaedic Residency, The MORE Foundation, Novi, MI, USA.
Arthroplast Today. 2021 Aug 18;10:175-179. doi: 10.1016/j.artd.2021.06.013. eCollection 2021 Aug.
Patients undergoing total joint arthroplasty have higher rates of anxiety, depression or anxiety and depression than the general population and higher costs of care, which lead to higher levels of postoperative dissatisfaction and readmission rates. We evaluated the readmission rates of patients undergoing total hip or knee arthroplasty with diagnoses of anxiety, depression, or both.
Our hospital's prospectively collected data from Michigan's statewide total joint database were reviewed from 2013 to 2018. Rates of anxiety, depression or anxiety and depression were determined based on preoperative anxiolytic or antidepressant medications using National Drug Codes.
A total of 4107 cases were included. Of which 4.28% had a readmission within the 90-day global period, and 12% had a history of depression or anxiety or both. For the entire cohort, those on anxiolytic medication were 153% more likely to be readmitted than those not on medication ( = .017). When comparing total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients taking anxiolytic medication and undergoing TKA were 120% more likely to undergo readmission within 90 days ( = .021). Patients on depression medication alone were not at increased risk of readmission in the TKA cohort ( = .991). For THA, neither diagnosis appeared a risk factor for readmission ( = .852).
Patients with depression, anxiety, or both undergoing TKA were at a statistically significant risk of readmission within 90 days compared with patients without these diagnoses. Anxiety and depression were both risk factors for readmission, but anxiety appeared to have a more significant impact. Patients undergoing THA on the other hand did not appear to share this risk profile.
接受全关节置换术的患者出现焦虑、抑郁或焦虑合并抑郁的比例高于普通人群，且护理成本更高，这导致术后不满程度和再入院率更高。我们评估了诊断为焦虑、抑郁或两者皆有的接受全髋关节或全膝关节置换术患者的再入院率。
回顾了我院2013年至2018年从密歇根州全州全关节数据库前瞻性收集的数据。根据术前使用国家药品编码的抗焦虑或抗抑郁药物确定焦虑、抑郁或焦虑合并抑郁的发生率。
共纳入4107例病例。其中，4.28%在90天的整体观察期内再次入院，12%有抑郁或焦虑病史或两者皆有。对于整个队列，服用抗焦虑药物的患者再次入院的可能性比未服药的患者高153%（P = 0.017）。在比较全髋关节置换术（THA）或全膝关节置换术（TKA）时，服用抗焦虑药物并接受TKA的患者在90天内再次入院的可能性高120%（P = 0.021）。仅服用抗抑郁药物的患者在TKA队列中再次入院的风险并未增加（P = 0.991）。对于THA，两种诊断均未显示为再次入院的风险因素（P = 0.852）。
与无这些诊断的患者相比，患有抑郁、焦虑或两者皆有的接受TKA的患者在90天内再次入院的风险具有统计学意义。焦虑和抑郁都是再次入院的风险因素，但焦虑似乎有更显著的影响。另一方面，接受THA的患者似乎不存在这种风险情况。
