Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up
Preoperative Anxiety and Depression Correlate With Dissatisfaction After Total Knee Arthroplasty: A Prospective Longitudinal Cohort Study of 186 Patients, With 4-Year Follow-Up
复制标题
DOI：
10.1016/j.arth.2016.08.033
复制
发表时间：
2017-03-01
影响因子：
3.5
通讯作者：
Flivik, Gunnar
中科院分区：
文献类型：
--
作者：
Ali, Abdulemir;Lindstrand, Anders;Flivik, Gunnar
背景资料：全膝关节置换术（TKA）经过40多年的经验，仍有一批患者对结果不满意。尽管围绕手术的许多方面有所改善，但由于无法解释的原因，患者的不满意度仍然大致相同。我们进行了这项研究，分析术前心理方面和不满后TKA。方法：共186例患者进行了手术与初次TKA。患者在术前和术后4年填写医院焦虑和抑郁量表、视觉模拟疼痛量表（0-100）和膝关节损伤和骨关节炎结局评分。术后4年，患者还对手术结果进行了满意度评分。结果：在186例患者中，27例（15%）报告称他们对术后4年的TKA结果不满意或不确定。这27名患者中有16名患者在术前报告了焦虑/抑郁，而满意或非常满意组中有11名患者（7%）在术前报告了焦虑/抑郁。与没有焦虑或抑郁的患者相比，患有术前焦虑或抑郁的患者不满意的风险高出6倍以上（P < .001）。假体深部感染患者对手术结果不满意的风险高3倍（P = .03）。不满意组患者住院时间较满意组多1天（P <0.001）。结论：术前焦虑和/或抑郁是TKA术后不满意的重要预测因素。术前进行心理评估和治疗可提高患者的满意度。(C)2016 Elsevier Inc. All rights reserved.
Background: After more than 4 decades experience of total knee arthroplasty (TKA), there is still a group of patients who are not satisfied with the outcome. In spite of the improvement of many aspects around the procedure, for unexplainable reasons, patient dissatisfaction is still approximately the same. We conducted this study to analyze correlations between preoperative psychological aspects and dissatisfaction after TKA.Methods: A total of 186 patients were operated with a primary TKA. Patients filled out the Hospital Anxiety and Depression Scale, Visual Analog Pain Scale (0-100), and Knee injury and Osteoarthritis Outcome Score preoperatively and 4 years postoperatively. Four years postoperatively, the patients also scored their satisfaction degree with the outcome of the surgery.Results: Of 186 patients, 27 (15%) reported that they were dissatisfied or uncertain with the result of their TKA 4 years postoperatively. Sixteen of those 27 patients had reported anxiety/depression preoperatively compared with 11 of 159 (7%) in the satisfied or very satisfied groups. Patients with preoperative anxiety or depression had more than 6 times higher risk to be dissatisfied compared with patients with no anxiety or depression (P < .001). Patients with deep prosthetic infection had 3 times higher risk to be dissatisfied with the operation outcome (P = .03). Dissatisfied patients had 1-day longer hospital stay compared with the satisfied group (P < .001).Conclusion: Preoperative anxiety and/or depression is an import predictor for dissatisfaction after TKA. Psychological assessment and treatment preoperatively might improve degree of satisfaction. (C) 2016 Elsevier Inc. All rights reserved.