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 This added risk is something doctors and patients should discuss in
advance, the study team writes in The Journal of Arthroplasty.
Previous studies have linked depression and other mental illnesses
to greater complications after surgery and worse outcomes for
patients, the researchers note.
In particular, patients with psychiatric disease are known to have
more complications after cardiac, spine and general surgery, lead
author Dr. Mitchell Klement told Reuters Health.
“We wanted to see if the same effect was true in total hip
replacements,” said Klement, an orthopedic surgery resident at Duke
University Medical Center in North Carolina.
Total hip arthroplasty, done to relieve pain from advanced hip
arthritis, involves replacing the hip joint with an artificial one
and is usually very successful, the authors note.
But complications can range from pain and infections to blood clots
and stroke, failure of the surgical wound to heal, heart rhythm
abnormalities and heart failure, kidney failure and respiratory
failure.
To determine how mental illness might affect healing after hip
surgery, the researchers analyzed data from Medicare, the government
insurance for elderly and disabled, from 2005 to 2011.
They identified 86,976 patients who had hip replacements and also
had a diagnosis of one or more of three common psychiatric diseases.
Within this group, 5,626 had bipolar disorder, 82,557 had depression
and 3,776 had schizophrenia.
The researchers compared them to 590,689 people who had hip surgery
but did not have a mental illness.
The patients with psychiatric diagnoses were more likely than those
without mental illness to be younger than 65, female and to have
additional medical problems.
Three months after surgery, patients with mental illness were more
likely to have had 13 of the 14 medical complications studied.
The artificial hips of people with mental illness were more than
twice as likely to get infected, break or get dislocated, for
example.
Hip surgery patients with psychiatric disease were also nearly twice
as likely to need revision surgery on their hip replacement. And
they were more than twice as likely to have respiratory failure and
pneumonia.
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There were no significant differences in outcomes between the people
with depression, bipolar disorder or schizophrenia.
“Psychiatric states reduce the ability to self-manage and follow
instructions, reduce motivation for self-management, and (make it
difficult to pay) attention to recommendations to protect their
surgical joints effectively,” said Ray Marks, a clinical professor
at York College in New York who studies arthritis surgery and mental
illness.
People with mental illness may be more likely to have weaker immune
systems, more body fat and diabetes, all factors that can have
impair healing from surgery, Marks, who was not involved in the
study, told Reuters Health by email.
People with anxiety or depression that's not being treated should
discuss this with their doctor. They should be aware that doctors
may not ask them about these issues, so they may have to bring it up
in order to get help, she said.
“If they get help, they will have less overall pain, sleep better,
and be able to improve their health outlook and health outcomes, and
reduce the risk of postoperative complications,” Marks added.
“Patients with these conditions can still have a total hip
replacement and achieve excellent relief from their arthritis pain.
However, they should know that the rates of problems after surgery
might be higher,” Klement noted.
“Patients should do their best to make sure all of their medical
issues are under control and practice healthy exercise and eating
habits in the months before their surgery,” Klement said.
SOURCE: bit.ly/1Qqh4FM The Journal of Arthroplasty, online March 17,
2016.
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