Highlights
- •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.
Abstract
Objective
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.
Conclusions
Adults experiencing worse preoperative psychological health before total knee arthroplasty
may have a longer hospital stay compared to those with unremarkable psychological
health.
Keywords
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References
- International survey of primary and revision total knee replacement.Int Orthop. 2011; 35: 1783-1789
- Surgical Variance Report: Orthopaedic Procedures 2016.(Available at:)https://www.surgeons.org/media/24529112/mpl-racs_orthopaedic_procedures.pdfDate accessed: April 28, 2018
- Direct cost and complications associated with total joint arthroplasty in patients with preoperative anxiety and depression.J Arthroplasty. 2016; 31: 533-536
- Hospital performance: Costs of admitted patients in public hospitals in 2011-12.(Available at:)https://www.myhospitals.gov.au/our-reports/cost-of-acute-admitted-patients/april-2015/media/infographics-postersDate: 2015Date accessed: April 28, 2018
- Hospital performance: Length of stay. Victorian Auditor-General’s Report.Victorian Auditor-General’s Office, Melbourne, Australia2016
- Admitted patient care 2015-16: Australian hospital statistics. Australian Institute of Health and Welfare, Canberra, Australia2017
- Independent Hospital Pricing Authority Annual Report 2013-14. Independent Hosing Pricing Authority, Sydney, Australia2014
- Predicting risk of extended inpatient rehabilitation after hip or knee arthroplasty.J Arthroplasty. 2003; 18: 775-779
- Simplified frailty index as a predictor of adverse outcomes in total hip and knee arthroplasty.J Arthroplasty. 2016; 31: 2389-2394
- Length of stay and short-term functional outcomes after total knee arthroplasty: Can we predict them?.Knee. 2016;
- A prediction model for length of stay after total and unicompartmental knee replacement.Bone & Joint Journal. 2013; 95B: 1490-1496
- Mental health: a state of well-being.(Available at:)http://www.who.int/features/factfiles/mental_health/en/Date accessed: December 20, 2016
- Increased preoperative narcotic use and its association with postoperative complications and length of hospital stay in patients undergoing spine surgery.Clinical Spine Surgery. 2016; 29: E93-E98
- The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty.J Shoulder Elbow Surg. 2014; 23: 519-527
- Total knee replacement outcome and coexisting physical and emotional illness.Clin Orthop Relat Res. 2005; 440: 157-161
- Predicting total knee replacement pain: a prospective, observational study.Clin Orthop Relat Res. 2003; 416: 27-36
- Do psychological factors predict poor outcome in patients undergoing TKA? A systematic review.Clin Orthop Relat Res. 2015; 473: 2630-2638
- Psychological factors affecting the outcome of total hip and knee arthroplasty: a systematic review.Semin Arthritis Rheum. 2012; 41: 576-588
- Preoperative psychological distress and functional outcome after knee replacement.ANZ J Surg. 2011; 81: 681-687
- Predicting dissatisfaction following total knee replacement.J Bone Joint Surg [Br]. 2010; 92-B: 1253-1258
- Prevalence of depressive symptoms and anxiety in osteoarthritis: a systematic review and meta-analysis (Stubbs, 2016 #5192).Age Ageing. 2016; 45: 228-235
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLOS Medicine. 2009; 6e1000097
- Identification of randomized controlled trials in systematic reviews: accuracy and reliability of screening records.Stat Med. 2002; 21: 1635-1640
- Systematic reviews of etiology and risk.in: Aromataris E. Munn Z. The Joanna Briggs Institute reviewer’s manual. The University of Adelaide, Adelaide, South Austrailia2017 (Available at:) (Accessed May 17, 2018)
- Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up.J Arthroplasty. 2016; 32: 767-770
- The outcome of primary total hip and knee arthroplasty in patients aged 80 years or more.J Bone Joint Surg [Br]. 2011; 93: 1265-1270
- Development of a prognostic nomogram for predicting the probability of nonresponse to total knee arthroplasty 1 year after surgery.J Arthroplasty. 2016; 31: 1654-1660
- A randomized controlled trial of postoperative analgesia following total knee replacement: transdermal Fentanyl patches versus patient controlled analgesia (PCA).Eur J Orthop Surg Traumatol. 2015; 25: 1073-1079
- Health related quality of life outcomes after total hip and knee arthroplasties in a community based population.J Rheumatol. 2000; 27: 1745-1752
- Characterization of patients undergoing total knee arthroplasty in a real-world setting and pain-related medication prescriptions for management of postoperative pain.J Pain Palliat Care Pharmacother. 2012; 26: 326-333
- Preoperative pain, symptoms, and psychological factors related to higher acute pain trajectories during hospitalization for total knee arthroplasty.PLoS ONE. 2016; 11e0161681
- An outcome study on average length of stay following total hip and knee replacement.Journal of Orthopaedic Nursing. 2002; 6: 161-169
- Patient and perioperative variables affecting 30-day readmission for surgical complications after hip and knee arthroplasties: a matched cohort study.J Arthroplasty. 2016; 32: 1074-1079
- Psychiatric disorders and psychopharmacologic treatment as risk factors in elective fast-track total hip and knee arthroplasty.Anesthesiology. 2015; 123: 1281-1291
- Focused risk analysis: regression model based on 5,314 total hip and knee arthroplasty patients from a single institution.J Arthroplasty. 2014; 29: 2031-2035
- Postoperative morbidity and discharge destinations after fast-track hip and knee arthroplasty in patients older than 85 years.Anesth Analg. 2016; 122: 1807-1815
- Psychological factors associated with short-term recovery from total knee replacement.Br J Health Psychol. 2001; 6: 41-52
- Catastrophic thinking about pain as a predictor of length of hospital stay after total knee arthroplasty: a prospective study.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1189-1194
- The influence of psychiatric comorbidity on perioperative outcomes following primary total hip and knee arthroplasty; a 17-year analysis of the national hospital discharge survey database.J Arthroplasty. 2015; 30: 165-170
- Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study.J Arthroplasty. 2014; 29: 481-483
- Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study.Psychosomatics. 2013; 54: 149-157
- The need for a new medical model: a challenge for biomedicine.Science. 1977; 196: 129-136
- Does preoperative anxiety and depression predict satisfaction after total knee replacement?.Knee. 2012; 19: 522-524
- Physical therapist–delivered pain coping skills training and exercise for knee osteoarthritis: randomized controlled trial.Arthritis Care Res. 2016; 68: 590-602
- Association between psychological health and wound complications after surgery.Br J Surg. 2017; 104: 769-776
- An enhanced recovery after surgery program for hip and knee arthroplasty.Med J Aust. 2015; 202: 363-369
- Fast-track hip and knee arthroplasty.Lancet. 2013; 381: 1600-1602
- The role of psychiatric diagnoses for outcome after hip and knee arthroplasty.J Arthroplasty. 2017; 32: 3611-3615
- Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector.BMC Health Serv Res. 2017; 17: 415
Medibank RACoSa. Surgical Variance Report 2017—Orthopaedic Surgery 2017: Australia. Available at: https://surgeons.org/media/25492528/surgical-variance-reports-2017-orthopaedic-surgery.pdf.Accessed March 1, 2018
- The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues.J Bone Joint Surg Am. 2013; 95e165
- Kinesiophobia and depression affect total knee arthroplasty outcome in a multivariate analysis of psychological and physical factors on 200 patients.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 3417-3423
- The role of preoperative self-efficacy in predicting outcome after total knee replacement.Musculoskeletal Care. 2012; 10: 110-118
- Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement.Acta Orthop. 2017; 88: 530-536
- Fall-related admissions after fast-track total hip and knee arthroplasty—cause of concern or consequence of success?.Clin Interv Aging. 2013; 8: 1569-1577
- Psychiatric disorders, psychotropic medication use and falls among women: an observational study.BMC Psychiatry. 2015; 15: 75
Article info
Publication history
Published online: April 25, 2018
Footnotes
This review was prospectively registered on the PROSPERO database, registration number CRD42016052546.
Disclosures: none.
Identification
Copyright
Crown Copyright © 2018 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine