有记录和无记录的精神疾病状况会影响全髋关节置换术后的住院时间和出院处置。
Documented and Undocumented Psychiatric Conditions Affect the Length of Stay and Discharge Disposition Following Total Hip Arthroplasty.
作者信息
Passano Brandon, Oakley Christian T, Singh Vivek, Lygrisse Katherine A, Schwarzkopf Ran, Lajam Claudette M
机构信息
Department of Orthopedic Surgery, NYU Langone Hospital - Long Island, Mineola, NY.
Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
出版信息
J Arthroplasty. 2022 Apr;37(4):727-733. doi: 10.1016/j.arth.2021.11.040. Epub 2021 Dec 10.
BACKGROUND
Despite increased efforts toward patient optimization, some patients have undocumented conditions that can affect costs and quality metrics for institutions and physicians. This study evaluates the effect of documented and undocumented psychiatric conditions on length of stay (LOS) and discharge disposition following total hip arthroplasty (THA).
METHODS
A retrospective review of all primary THAs from 2015 to 2020 at a high-volume academic orthopedic specialty hospital was conducted. Patients were separated into 3 cohorts: patients with a documented psychiatric diagnosis (+Dx), patients without a documented psychiatric diagnosis but with an actively prescribed psychiatric medication (-Dx), and patients without a psychiatric diagnosis or medication (control). Patient demographics, LOS, and discharge disposition were assessed.
RESULTS
A total of 5309 patients were included; 3048 patients had no recorded psychiatric medications (control); 2261 patients took at least 1 psychiatric medication, of which 1513 (65.9%) and 748 (34.1%) patients were put in the -Dx and +Dx cohorts, respectively. American Society of Anesthesiologists class differed between groups (P < .001). The -Dx and +Dx groups had increased LOS (3.15 ± 2.37 [75.6 ± 56.9] and 3.12 ± 2.27 [74.9 ± 54.5] vs 2.42 ± 1.70 [57.6 ± 40.8] days (hours), P < .001) and were more likely to be discharged to a secondary facility (23.0% and 21.7% vs 13.8%, P < .001) than the control group. Outcomes did not significantly differ between the -Dx and +Dx cohorts.
CONCLUSION
Most THA patients' psychiatric diagnoses were not documented. The presence of psychiatric medications was associated with longer LOS and a greater likelihood of discharge to secondary facilities. This has implications for both cost and quality metrics. Review of medications can help identify and optimize these patients before surgery.
LEVEL III EVIDENCE
Retrospective Cohort Study.
背景
尽管在优化患者治疗方面付出了更多努力，但仍有一些患者存在未记录的病情，这可能会影响机构和医生的成本及质量指标。本研究评估了记录在案和未记录在案的精神疾病状况对全髋关节置换术（THA）后住院时间（LOS）和出院处置的影响。
方法
对一家大型学术性骨科专科医院2015年至2020年期间所有初次全髋关节置换术患者进行回顾性研究。患者被分为三组：有记录在案的精神疾病诊断的患者（+Dx）、无记录在案的精神疾病诊断但正在积极服用精神科药物的患者（-Dx）以及无精神疾病诊断或未服用精神科药物的患者（对照组）。评估患者的人口统计学特征、住院时间和出院处置情况。
结果
共纳入5309例患者；3048例患者未记录有精神科药物（对照组）；2261例患者至少服用1种精神科药物，其中1513例（65.9%）和748例（34.1%）患者分别被归入-Dx组和+Dx组。美国麻醉医师协会分级在各组之间存在差异（P <.001）。-Dx组和+Dx组的住院时间延长（分别为3.15±2.37[75.6±56.9]天和3.12±2.27[74.9±54.5]天，而对照组为2.42±1.70[57.6±40.8]天，P <.001），且比对照组更有可能被转至二级医疗机构（分别为23.0%和21.7%，而对照组为13.8%，P <.001）。-Dx组和+Dx组的结果无显著差异。
结论
大多数全髋关节置换术患者的精神疾病诊断未被记录。服用精神科药物与更长的住院时间以及转至二级医疗机构的可能性增加有关。这对成本和质量指标均有影响。术前审查药物有助于识别并优化这些患者。
三级证据
回顾性队列研究。
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