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

Studies conflict regarding the impact of psychiatric illnesses including depression, anxiety, dementia and schizophrenia on perioperative outcomes following total hip (THA) and knee arthroplasty (TKA). Psychiatric comorbidity incidence, in-hospital adverse events, discharge disposition, and mortality were assessed for THA or TKA patients between 1990 and 2007 using the US National Hospital Discharge Survey. A cohort representative of 8,379,490 patients was identified and analyzed using multivariable regression analysis. Diagnoses of depression, dementia and schizophrenia were associated with increased odds of adverse events (P < 0.001). Schizophrenia and depression were associated with higher odds of perioperative blood transfusion (P < 0.001). All psychiatric comorbidities were associated with higher odds of non-routine discharge (P < 0.001). Diagnosis of dementia was associated with higher in-hospital mortality (P < 0.001).