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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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
