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Screen patients to reduce the influence of mental diseases on surgical outcomes
A recently published, large study from investigators at the Mayo Clinic and the University of Alabama at Birmingham in the United States confirms what many orthopaedic surgeons have speculated about for years. Patients with mental diseases and mental illnesses have an increased risk of an inferior outcome after total knee replacement.
At my own clinic, we have run comparable studies, although on a lesser scale, which focused on patients with shoulder disease and patients with spinal disease who requested and underwent surgery. The results showed a clear trend that when compared to patients without mental illness diagnoses, patients who are diagnosed and treated for mental illnesses complain more frequently of postoperative pain or inferior functional outcomes. We found that the pain and functional results also differed from the patients’ own preoperative expectations.
Given these observations by the investigators at the Mayo Clinic and the University of Alabama, as well as researchers at my clinic, it seems reasonable to establish clinical trials in which patients with mental diseases — both psychiatric diseases and dementia — undergo an extra examination by a psychiatric specialist or their general practitioner before any decision about elective surgery is made. The role of the specialist or general practitioner would be to ensure that the patient is in his or her best mental state for the procedure and no additional treatment can be offered in place of surgery.
I urge orthopaedic surgeons to regularly screen their patients for signs and symptoms related to mental diseases. This practice will provide us with a better overview of each patient’s condition before we make a decision in favor of total joint replacement or other surgery.
It may be possible to learn new information from clinical trials in this area. The trials may shed light on the reasons why a large proportion of dissatisfied patients have unexplained pain, low patient-reported outcome measurement scores and why the patients have increased postoperative comorbidity in general. Results also may show this is more related to a patient’s mental status than the surgical treatment. Such findings may also help orthopaedic surgeons establish a better, personalized prognosis for each patient.
Currently, when total hip replacement surgery is decided on as the best option for a given patient and the patient asks about his or her chances of not being completely pain-free afterward or the risks for complications, we have sufficient data to discuss such complications as deep venous thrombosis, deep infection, leg length discrepancy and dislocation with them. It is my hope that soon we will be able to add to the discussion information about the patient’s chances for complete pain relief based on his or her mental disease profile.
I encourage investigators to continue to study the impact of mental diseases on orthopaedic surgery outcomes, as the results will be important to surgeons as well as patients.
- Reference:
- Singh JA. BMC Musculoskelet Disord. 2014;doi:10.1186/1471-2474-15-127.
- For more information:
- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.