Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review

  • Marie K. March
    Corresponding author Marie K. March, BAppSc(Phty), Physiotherapy Department, Blacktown Hospital, PO Box 792, Seven Hills, NSW 2147, Australia.
    Western Sydney Local Health District, Blacktown Mount Druitt Hospital, Physiotherapy Department, Mount Druitt, Australia

    University of Sydney, Faculty of Health Sciences, Musculoskeletal Health Research Group, Sydney, Australia
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  • Alison R. Harmer
    University of Sydney, Faculty of Health Sciences, Musculoskeletal Health Research Group, Sydney, Australia
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  • Sarah Dennis
    University of Sydney, Faculty of Health Sciences, Musculoskeletal Health Research Group, Sydney, Australia

    South Western Sydney Local Health District, Sydney, Australia

    Ingham Institute for Applied Medical Research, Liverpool, Australia
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Published:April 25, 2018DOI:


      • It is likely that poor preoperative psychological health leads to longer length of stay after total knee arthroplasty.
      • Standardized reporting of both psychological health and length of stay would allow calculation of effect sizes.
      • Preoperative assessment of psychological health can improve service planning by health services.



      To systematically review the literature to determine if preoperative psychological health affected hospital length of stay among adults following primary unilateral total knee arthroplasty.

      Data Sources

      Systematic review. We searched 6 online databases for original research published before December 31, 2016, that investigated adults undergoing primary unilateral total knee arthroplasty.

      Study Selection

      We included studies that used any measure of preoperative psychological health and reported length of stay, irrespective of study design. We excluded studies that considered participants with cognitive impairment or substance abuse; studies that considered participants who experienced revision, bilateral or hip surgery; and studies that did not have full text available in English.

      Data Extraction

      One review author screened 438 titles and abstracts for inclusion. Another author reviewed a 10% sample of excluded studies for adherence to the review protocol, with no violations observed. For all included studies, 2 authors independently extracted data from each study using a form designed a priori and independently assessed study quality according to the Joanna Briggs Checklist for Cohort Studies.

      Data Synthesis

      In view of the heterogeneity of the included studies, we present a narrative synthesis . Of the 7 included studies, 5 reported statistically significant increases in hospital length of stay among those with worse preoperative psychological health. These differences were often <1 calendar day, and, therefore, the clinical significance of these results remains unknown, but the potential to reduce health care costs may still be significant.


      Adults experiencing worse preoperative psychological health before total knee arthroplasty may have a longer hospital stay compared to those with unremarkable psychological health.


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