Table 2.

Studies evaluating the association between psychiatric illness and TJA complications

Study	Key findings	Factors controlled for
Browne et al. 2014 [11]	Although patients with depression had slightly higher odds of anemia, infection, and PE as well as moderately higher odds of postoperative psychosis, they had slightly lower odds of cardiac and gastrointestinal complications from TJA.	Age, procedure year, race, gender, CCI
Buller et al. 2015 [14]	Patients with depression had slightly and schizophrenia had modestly higher odds of adverse events. Patients with anxiety had slightly lower odds of adverse events after TJA.	Age, gender, procedure, comorbidities, discharge disposition, days of care
Chuang et al. 2021[15]	No difference in odds of having any complications after TKA between patients with depression and those without. Also, there was no difference in odds of wound infection, blood transfusion, DVT, or PE.	Age, race, insurance status
Gholson et al. 2018 [26]	Patients with schizophrenia had largely increased odds of developing medical complications and modestly more likely to develop surgical complications after TJA. Specifically, the odds of pulmonary complications and postoperative altered mental status were markedly higher while GU complications, transfusion, and acute postoperative hemorrhagic anemia were modestly increased. No difference reported in odds of wound infection, PJI, dislocation, thrombocytopenia, PE, DVT, or cardiac or GI complications.	Age, sex, smoking status, race, CCI
Kamalapathy et al. 2021 [42]	30-day and 90-day medical as well as surgical complication rates for patients with anxiety or depression were not elevated. However, patients with severe mental illness were more likely to experience a medical complication by 30 and 90 days. No difference reported in 30-day or 90-day severe mental illness surgical complication odds.	Age, sex, comorbidities, substance use
Klement et al. 2016 [46]	Patients undergoing TKA with any psychiatric illness had higher odds of medical and surgical complication rates at 30 and 90 days, particularly the odds of CHF, DVT, PE, AKI, acute postoperative hemorrhagic anemia, bleeding complications, and blood transfusion were modestly higher. PJI, wound complications, and CHF had largely higher odds. However, there was slightly less odds of MI or developing arrythmias reported.	Age, sex, comorbidities, tobacco use
Klement et al. 2016 [45]	At 30 and 90 days, patients undergoing TKA with depression had slightly elevated odds of bleeding, transfusion, DVT, PE, and CHF as well as largely increased odds of respiratory failure, wound complications, PJI, and periprosthetic fracture. However, there was slightly less odds of MI or developing arrythmias reported. Patients with schizophrenia had modestly decreased odds of developing arrythmias with or without atrial fibrillation and no difference in odds for MI. However, these patients also had modestly higher odds of DVT, PE, bleeding, transfusion, and CHF as well as largely increased odds of respiratory failure, wound complications, PJI, and periprosthetic fracture. Patients with bipolar disorder had slightly increased odds of transfusion, MI, arrythmias with atrial fibrillation, and bleeding complications. They also had largely higher odds of CHF, DVT, PE, PJI, and periprosthetic fracture as well as markedly increased odds of wound complications and respiratory failure.	Gender, age
Kooner et al. 2021 [48]	TJA patients with a psychiatric diagnosis were not at higher odds of experiencing a mechanical or medical adverse event overall. Also, as the only specific complications mentioned, no difference in odds for transfusion and postoperative infection.	Surgery type, year of surgery, age, sex, and medical comorbidities
Pan et al. 2019 [59]	After TKA, patients with depression had both slightly higher odds of AKI, anemia, MI, PE, pneumonia, and stroke but had slightly lower odds for postoperative infection, cardiac, GI, and CNS complications. No difference in odds for hemorrhage. Patients with anxiety had slightly higher odds of anemia, MI, pneumonia, and stroke. No difference in odds for AKI, postoperative infection, PE, cardiac, GI, GU, or CNS complications. Patients with both anxiety and depression had slightly higher odds of anemia, PE, pneumonia, and stroke compared to patients with no psychiatric illnesses. No difference in odds of AKI, hemorrhage, MI, cardiac, GI, GU, and CNS complications. Also, patients with both diagnoses had largely lower odds of postoperative infection.	Sex, age, race, hospital location, bed size, LOS
Paredes et al. 2020 [60]	Having anxiety and/or depression was associated with slightly higher odds of TJA complications overall, with a severe mental illness diagnosis having modestly higher odds.	Age, sex, CCI, race, discharge disposition
Seagrave et al. 2021 [70]	No difference in the odds of major TJA complications, VTE, wound dehiscence, fracture at surgical site, dislocation, or joint bleed between patients with anxiety and/or depression and patients without a psychiatric illness in covariate-adjusted analysis. However, TKA patients with anxiety and/or depression had slightly higher odds of developing a surgical site infection.	Age, sex, BMI, comorbidities, education level, LOS
Stundner et al. 2013 [78]	There was no difference in the overall odds for developing complications in TJA patients with depression compared to those without any psychiatric illness, but they had slightly increased odds for sepsis, cardiac complications excluding MI, and pneumonia. No difference reported in odds for VTE, MI, shock, pulmonary complications, or stroke. Patients with anxiety had slightly lower overall odds of developing complications, as well as stroke and cardiac complications including MI. There was no difference in odds of pulmonary complications, sepsis, and shock. Patients with anxiety had slightly higher odds of VTE and pneumonia. Also, there was no difference in overall odds of developing any complication for patients with concomitant anxiety and depression compared to patients without either diagnosis. No difference was reported in odds of VTE, pneumonia, cardiac complications, sepsis, or pulmonary complications. There were not enough data to assess for odds of MI and stroke.	Age, sex, race, hospital size, hospital location, and teaching status
Vakharia et al. 2019 [84]	TKA patients with schizophrenia had markedly higher odds of total medical complications and modestly higher odds of total implant complications compared to patients without schizophrenia. Transfusions, acute post-hemorrhagic anemia, and pneumonia all had markedly higher odds in schizophrenics. Also, there were modestly higher odds of stroke, UTI, AKI, thrombocytopenia, PE, DVT, dislocation, periprosthetic fractures, and PJI reported. No difference in odds for mechanical loosening or broken prosthetic implants reported.	Age, sex, region, comorbidities, CCI, discharge status, state, year, quarter, months, and date of index operation
Vakharia et al. 2020 [83]	90-day medical complications were largely and 2-year implant complications were modestly increased after TKA in patients with a depressive disorder. Transfusions, thrombocytopenia, UTI, stroke, and pneumonia had largely higher odds in patients with depression while acute respiratory insufficiencies, AKI, acute post-hemorrhagic anemia, paralytic ileus, PE, DVT, broken prosthetic joint, periprosthetic fracture, mechanical loosening, dislocation, and PJI all had modestly elevated odds.	Age, sex, and medical comorbidities associated with depressive disorders
Zalikha et al. 2021 [95]	Patients undergoing TJA who had depression, anxiety, or both had slightly higher odds of experiencing any in-hospital complication. Patients with depression had slightly decreased odds of cardiac, respiratory, GI, and GU complications as well as slightly increased odds of wound dehiscence, infection, PE, and postoperative anemia. No difference in odds of DVT reported. Patients with anxiety had slightly lower odds of GI complications as well as no difference in the odds of cardiac, respiratory, GU complications, wound dehiscence, infection, DVT, or PE. Patients with anxiety as well as concomitant depression and anxiety had a modestly increased odds of developing anemia postoperatively. Patients with concomitant depression and anxiety had no difference in cardiac or GU complications, infection, or PE. There were not enough data to assess for odds of respiratory or GI complications or wound dehiscence.	Age, BMI, race, hospital size, location, region of hospital

TJA = total joint arthroplasty; PE = pulmonary embolism; CCI = Charlson comorbidity index; DVT = deep vein thrombosis; GU = genitourinary system; PJI = periprosthetic joint infection; GI = gastrointestinal system; CHF = congestive heart failure; AKI = acute kidney injury; MI = myocardial infarction; CNS = central nervous system; LOS = length of stay; VTE = venous thromboembolism; UTI = urinary tract infection.