Gholson JJ, et al. - This study was performed to assess the impact of schizophrenia on the outcomes of total joint arthroplasty (TJA). Findings revealed that total joint arthroplasty had markedly higher complications among patients with schizophrenia. Particularly, there appeared higher pulmonary complications, mechanical complications of the implant, mental status changes, and transfusion rates, which were possibly related to antipsychotic medications.

Methods

• Researchers used the nationwide inpatient sample (NIS) to assess a cohort of 505,840 patients having total hip arthroplasty between 2009 and 2012.
• In this cohort, 953 patients (0.2%) were diagnosed with schizophrenia.
• The impact of schizophrenia on short-term medical and surgical complications was determined using multivariate logistic regression.
• They also compared the differences in length of stay and discharge disposition.

Results

• After controlling for smoking and other demographic differences through propensity matching, schizophrenic patients were 15 times more likely to have pulmonary insufficiency following surgery (OR 15.1, p=0.0133).
• These patients showed an eleven times elevated risk for mental status changes (OR 11.1, p=0.0002), three time elevated risk for a mechanical complication of the implant (OR 3.2, p=0.0031), and two times higher tendency for requiring a transfusion (OR 2.4, p< 0.0001).
• Schizophrenic patients showed higher all-cause medical (OR 2.2, p < 0.0001), and surgical (OR 1.5, p < 0.0001) complications.
• Researchers noticed that patients stayed an average of 0.63 days longer in the hospital ( p < 0.0001), and were three times more likely to discharge to a facility post-operatively (OR 2.7, p < 0.0001).