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Should Depression Be Treated Before Lower Extremity Arthroplasty?
- Source :
- The Journal of Arthroplasty. 33:3143-3146
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Patient optimization is becoming increasingly important before arthroplasty to ensure outcomes. It has been suggested that depression is a modifiable risk factor that should be corrected preoperatively. It remains to be determined whether psychological intervention before surgery will improve outcomes. We theorized that the use of preoperative depression scales to predict postoperative outcomes may be influenced by the pain and functional disability of arthritis. To determine whether depression is a modifiable risk factor that should be corrected preoperatively we asked the following questions: (1) What is the prevalence of depression in arthroplasty patients preoperatively? (2) Do depressive symptoms improve after surgery? (3) Is preoperative depression associated with outcome? Methods Patients scheduled for surgery completed a patient health questionnaire (PHQ-9) to assess the presence and severity of depression pre-operatively and one year post-operatively. Results Sixty-five of the 282 patients had a PHQ-9 score >10 indicating moderate depression and 57 (88%) improved to P = .0012). Ten patients had a PHQ-9 score >20 indicating severe depression and 9 (90%) improved to P = .10). Of the 65 patients who had a PHQ-9 score >10 preoperatively, the median postoperative Hip Disability and Osteoarthritis Outcome Score (N = 40) was 92.3, while the median postoperative Knee Injury and Osteoarthritis Outcome Score (N = 25) was 84.6. The median postoperative Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score in nondepressed patients were 96.2 and 84.6, respectively ( P = .9041). Conclusion By diminishing pain and improving function through arthroplasty, depression symptoms improve significantly. Patients with depressive symptoms preoperatively had similar postoperative outcome scores compared to non-depressed patients. Patients should not be denied surgical intervention through optimization programs that include a depression scale threshold. Level of Evidence III.
- Subjects :
- Male
medicine.medical_specialty
Arthroplasty, Replacement, Hip
medicine.medical_treatment
Psychological intervention
Arthritis
Osteoarthritis
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Preoperative Care
Prevalence
medicine
Health Status Indicators
Humans
Orthopedics and Sports Medicine
Risk factor
Arthroplasty, Replacement, Knee
Depression (differential diagnoses)
Aged
030203 arthritis & rheumatology
030222 orthopedics
Depression
business.industry
Recovery of Function
Evidence-based medicine
Middle Aged
medicine.disease
Arthralgia
Arthroplasty
United States
Patient Health Questionnaire
Treatment Outcome
Female
business
Subjects
Details
- ISSN :
- 08835403
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- The Journal of Arthroplasty
- Accession number :
- edsair.doi.dedup.....317b1a857954298b211961d7a2db1743