Kotzur Travis, Singh Aaron, Peng Lindsey, Lundquist Kathleen, Peterson Blaire, Young William, Buttacavoli Frank, Moore Chance
From the Department of Orthopaedic Surgery, UT Health San Antonio, San Antonio, TX.
J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 23;8(12). doi: 10.5435/JAAOSGlobal-D-24-00098. eCollection 2024 Dec 1.
Depression is among the most common mental illnesses, with an estimated 8.1% of adults in the United States living with the condition. Despite its prevalence, the effect of depression on surgical outcomes is not well studied. The aim of this study is to assess the effect of diagnosed major depressive disorder on postoperative outcomes following total knee arthroplasty (TKA).
This retrospective cohort study used the National Readmissions Database from 2016 to 2019 to evaluate the effect of depression on 30-day outcomes following TKA. Patients with and without a diagnosis of depression were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. Propensity score matching was employed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression analyses were used to assess postoperative outcomes, 30-day readmission, and revision surgery rates.
Overall, 1,906,980 patients undergoing TKA, 302,853 (15.68%) with a diagnosis of depression, were included in our analysis. After matching, those with depression were more likely to have both medical (odds ratio [OR] 1.90; P < 0.001) and surgical complications (OR 1.86; P < 0.001), including periprosthetic fracture (OR 2.27; P < 0.001). In addition, they had increased odds of 30-day readmission (OR 1.98; P < 0.001) and revision surgery (OR 1.83; P < 0.001).
Depression is common in the TKA population, with 15.9% of patients having a diagnosis at the time of surgery. Furthermore, these patients experience a greater risk of complications following surgery. They are also at greater risk of requiring readmission or revision surgery. Overall, patients with depression may experience worse outcomes following TKA.
Level III; Retrospective Cohort Study.
抑郁症是最常见的精神疾病之一，据估计美国有8.1%的成年人患有此病。尽管其发病率很高，但抑郁症对外科手术结果的影响尚未得到充分研究。本研究的目的是评估确诊的重度抑郁症对全膝关节置换术（TKA）术后结果的影响。
这项回顾性队列研究使用了2016年至2019年的国家再入院数据库，以评估抑郁症对TKA术后30天结果的影响。使用国际疾病分类第10版临床修订本/手术编码系统（ICD-10）编码识别有和没有抑郁症诊断的患者。采用倾向评分匹配法来平衡两组患者的人口统计学特征、社会经济状况和合并症。多变量回归分析用于评估术后结果、30天再入院率和翻修手术率。
总体而言，我们的分析纳入了1,906,980例行TKA的患者，其中302,853例（15.68%）被诊断为抑郁症。匹配后，抑郁症患者更有可能出现医疗（优势比[OR]1.90；P<0.001）和手术并发症（OR 1.86；P<0.001），包括假体周围骨折（OR 2.27；P<0.001）。此外，他们30天再入院（OR 1.98；P<0.001）和翻修手术（OR 1.83；P<0.001）的几率增加。
抑郁症在TKA人群中很常见，15.9%的患者在手术时有诊断。此外，这些患者术后出现并发症的风险更大。他们再次入院或进行翻修手术的风险也更高。总体而言，抑郁症患者TKA术后的结果可能更差。
III级；回顾性队列研究。
