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trend. Cho et al.4) found that the prevalence of major depressive disorders in the elderly population ranged from 4.2% to 9.1%, the prevalence of clinically significant depressive symptoms was between 9.1% and 33.0%, alcohol-use disorders constituted up to 13.6%, and sleep disorders accounted for 22% to 58% of the elderly. Based on a survey on the prevalence of bipolar affective disorder, Jung et al.5) has reported that the prevalence is higher currently than in the past. It is also known that the rate of deaths by suicide in South Korea has been the highest among the members of the OrganizaOrthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions Jun-Il Yoo, MD, Yonghan Cha, MD*, Jung-Taek Kim, MD† , Chan Ho Park, MD‡ , Wonsik Choy, MD*, Kyung-Hoi Koo, MD§ Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, *Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, † Department of Orthopedic Surgery, Ajou Medical Center, Ajou University School of Medicine, Suwon, ‡ Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, § Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery. Keywords: Orthopedic surgery, Mental disorder, Depression, Assessment, Complication Review Article Clinics in Orthopedic Surgery 2022;14:155-161 • https://doi.org/10.4055/cios21156 Copyright © 2022 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Clinics in Orthopedic Surgery • pISSN 2005-291X eISSN 2005-4408 Received September 28, 2021; Revised February 28, 2022; Accepted April 4, 2022 Correspondence to: Yonghan Cha, MD Department of Orthopedic Surgery, Daejeon Eulji Medical Center, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea Tel: +82-42-611-3280, Fax: +82-42-611-3283 E-mail: naababo@hanmail.net 156 Yoo et al. Mental Disorder in Orthopedic Patients Clinics in Orthopedic Surgery • Vol. 14, No. 2, 2022 • www.ecios.org tion for Economic Cooperation and Development (OECD) since 2003.6) Therefore, orthopedic surgeons are likely to encounter patients with mental disorders in clinical situations, and identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Our purpose in this review article was to investigate the factors that orthopedic surgeons should consider before and after surgery for orthopedic patients with mental disorders and to introduce the factors that affect clinical outcomes of surgery. THE NEED FOR PSYCHIATRIC EVALUATION AND UNDERSTANDING OF BEHAVIORAL CHARACTERISTICS OF PATIENTS WITH MENTAL DISORDERS In cases of spinal cord stimulator implantation surgery for the control of complex regional pain syndrome, bariatric surgery, and gender transition surgery, psychiatric evaluation was needed before surgery because of the high possibility of accompanying mental illness, but recently the need for mental state examination is expanding to several operations, such as carpal tunnel surgery, temporomandibular disorder, deep brain-stimulator insertion for Parkinson disease, and cosmetic surgery.7) There are several reasons for which preoperative psychiatric evaluation is necessary. The first is that some operations, such as organ transplantation, amputations, and bariatric procedures, are expensive, and lifestyle changes or patient cooperation after surgery greatly affect clinical outcomes.8) The preoperative psychosocial evaluation process serves to establish a positive and trusting working relationship between the patient and medical personnel. Furthermore, established trust and rapport could enhance the patient’s willingness to change lifestyle or behavioral support.9) Second, psychiatric disorders increase the length of hospitalization after surgery, surgical complication rate, and in-hospital mortality rate, thereby increasing both the economic and psychological burden of the operator.10) Stone et al.11) reported that patients with a psychiatric diagnosis or psychotropic medication had increased healthcare utilization in the postoperative period after total hip and knee arthroplasty. Third, the
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