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Mental health is a consideration in patients undergoing planned orthopaedic surgery
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Mental health is not usually considered to be much of a factor that influences the overall outcome of patients who undergo planned orthopaedic surgical procedures, but studies are now starting to show that a patient’s mental health may be linked to poor outcomes after shoulder surgery, spine surgery and lower limb joint replacement. I am sure we are now just seeing the tip of the iceberg in this area.
Christoffer C. Jørgensen, MD, and members of The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group in Denmark showed poor mental health and other psychiatric disorders had a significantly negative effect not only on the overall outcome of hip and knee replacement, but also on the patient’s satisfaction and surprisingly on the patient’s postoperative morbidity and mortality, as well.
Being in orthopaedic surgery practice for more than 30 years, my personal experience has been confirmed by the findings of studies into psychological diagnoses in total joint arthroplasty performed by Lundbeck Foundation investigators, such as Jørgensen and Silas H. Gylvin, MD, and his colleagues. As surgeons, we need to take a new approach when we plan TJA and perhaps other elective surgeries. We should set-up a screening program to evaluate incoming patients’ mental health.
Some questionnaires for this purpose already exist but need further exploring. Also, we must be transparent and open with our patients about the reasons that we need to discuss mental and psychological health with them before surgery. In my experience, patients try to push the surgeon toward performing the surgery while denying their mental health is an issue. Furthermore, orthopaedic patients who have mental disorders must be referred to the general practitioner (GP) with the expectation that the GP can help the patient with management and treatment of the mental health condition. Another approach is to refer the patient directly to a psychiatrist who can correctly diagnose the condition and initiate proper treatment.
The question is: Once all of this has been done to put the patient with a mental disorder in his or her best condition before a trip to the OR, how will this change the outcome of any planned surgery? I still need good studies to answer this question and show me what to expect in terms of improved outcomes. Until these types of studies are conducted and published, orthopaedic surgeons should take extra care with their patients who have mental or psychological disorders to ensure patients’ expectations for the planned surgery are met.
- References:
- Gylvin SH, et al. J Arthroplasty. 2017; doi.org/10.1016/j.arth.2017.06.051.
- Jørgensen CC, et al. Anesthesiology. 2015;doi:10.1097/ALN.0000000000000632.
- Jørgensen CC, et al. Br J Anaesth. 2013;doi:10.1093/bja/aes505.
- 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: orthopedics@healio.com.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.