Depression Treatment Is Not Associated With Improved Patient-Reported Outcomes Following Total Joint Arthroplasty

Halawi, Mohamad J.; Gronbeck, Christian; Savoy, Lawrence; Cote, Mark P.; Lieberman, Jay R.

doi:10.1016/j.arth.2019.08.010

Cited by 16 publications

(17 citation statements)

References 14 publications

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“…Despite our knowledge of the relationship between depression and patient outcomes, it is unknown how exactly preoperative treatment for depression affects postoperative outcomes after hip arthroscopy. While there is mixed evidence surrounding this concept within the arthroplasty literature, 13 , 20 no studies to date have examined this topic in a population of patients undergoing hip arthroscopy; thus, further investigation is warranted to optimize patient outcomes and reduce postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy

Freshman

Salesky

Cogan

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Depression and related psychiatric diagnoses are common in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The effects of depression on postoperative complications, readmissions, and additional ipsilateral hip surgery are not well studied. Hypothesis: Patients with preoperative depression who undergo hip arthroscopy for FAIS would experience higher rates of 90-day postoperative complications and readmissions, with an increased risk of additional ipsilateral hip procedures, as compared with patients without depression. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study between 2010 and 2019 was performed using the Mariner/PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without preexisting depression who underwent hip arthroscopy for FAIS. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Patients undergoing shoulder or knee arthroscopy were also identified to compare lifetime preoperative depression prevalence amongst groups. Results: The lifetime preoperative depression prevalence was significantly higher in patients undergoing hip arthroscopy as compared with patients undergoing shoulder or knee arthroscopy (25.4% vs 22.2% vs 19.8%; P < .001). When compared with the patients without depression, patients with preoperative depression had higher rates of 90-day readmissions (2.4% vs 1.5%) and complications, including urinary tract infection (36.2% vs 28.9%), pneumonia (12.9% vs 9.1%), hematoma formation (3.1% vs 1.9%), acute kidney injury (4.0% vs 2.6%), deep venous thrombosis/pulmonary embolism (2.6% vs 1.7%), and superficial infection (4.9% vs 2.8%; P < .01 for all comparisons). Preoperative depression was associated with significantly higher odds of undergoing revision hip arthroscopy within 2 years (6.3% vs 2.4%; P < .001). Conclusion: Patients with preexisting depression experienced higher rates of 90-day postoperative complications and hospital readmissions after elective hip arthroscopy for FAIS and were more likely to undergo revision hip arthroscopy within 2 years of the index procedure.

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Section: Discussionmentioning

confidence: 99%

Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy

Freshman

Salesky

Cogan

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…As highlighted by a study by Kohring et al, even though "treated" and "untreated" depressed patients had similar physical function score improvements postoperatively, the patients who were untreated had a lower magnitude of change [12]. Contrasting this, a study by Halawi et al concluded that although preoperative depressive symptoms affected overall outcomes, treatment of these symptoms before surgical intervention did not mitigate the inferior outcomes [11]. The authors also recommended further study into alternative or additional interventions that could potentially improve the overall patient experience.…”

Section: Discussionmentioning

confidence: 97%

“…Contrasting this, a study by Halawi et al. concluded that although preoperative depressive symptoms affected overall outcomes, treatment of these symptoms before surgical intervention did not mitigate the inferior outcomes [ 11 ]. The authors also recommended further study into alternative or additional interventions that could potentially improve the overall patient experience.…”

Section: Discussionmentioning

confidence: 99%

“…With preoperative GAD, there was an association with higher levels of knee disability, significant functional limitations using Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, and decreased overall quality of life [ 5 , 9 ]. Although depression and anxiety are conceptually modifiable risk factors for complications, there are no current recommendations on the effects of preoperative treatment of these conditions, and recent investigations have led to authors urging more research into the possible benefit of preoperative therapy on patient outcomes [ [10] , [11] , [12] ].…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Depression and Anxiety on 90-day Readmission Rates After Total Hip and Knee Arthroplasty

et al. 2021

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Background Patients undergoing total joint arthroplasty have higher rates of anxiety, depression or anxiety and depression than the general population and higher costs of care, which lead to higher levels of postoperative dissatisfaction and readmission rates. We evaluated the readmission rates of patients undergoing total hip or knee arthroplasty with diagnoses of anxiety, depression, or both. Methods Our hospital’s prospectively collected data from Michigan’s statewide total joint database were reviewed from 2013 to 2018. Rates of anxiety, depression or anxiety and depression were determined based on preoperative anxiolytic or antidepressant medications using National Drug Codes. Results A total of 4107 cases were included. Of which 4.28% had a readmission within the 90-day global period, and 12% had a history of depression or anxiety or both. For the entire cohort, those on anxiolytic medication were 153% more likely to be readmitted than those not on medication ( P = .017). When comparing total hip arthroplasty (THA) or total knee arthroplasty (TKA), patients taking anxiolytic medication and undergoing TKA were 120% more likely to undergo readmission within 90 days ( P = .021). Patients on depression medication alone were not at increased risk of readmission in the TKA cohort ( P = .991). For THA, neither diagnosis appeared a risk factor for readmission ( P = .852). Conclusions Patients with depression, anxiety, or both undergoing TKA were at a statistically significant risk of readmission within 90 days compared with patients without these diagnoses. Anxiety and depression were both risk factors for readmission, but anxiety appeared to have a more significant impact. Patients undergoing THA on the other hand did not appear to share this risk profile.

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“…Mental health diagnoses and their treatment are becoming an increasingly relevant area of research on patients undergoing TKA. Several previous studies have demonstrated that a diagnosis of depression or anxiety negatively impacts outcomes after TKA [ 42 , 43 ]. In their series of 280 patients, Kohring et al.…”

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses

et al. 2022

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Depression Treatment Is Not Associated With Improved Patient-Reported Outcomes Following Total Joint Arthroplasty

Cited by 16 publications

References 14 publications

Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy

Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision Arthroscopic Procedures After Elective Hip Arthroscopy

The Effects of Depression and Anxiety on 90-day Readmission Rates After Total Hip and Knee Arthroplasty

Depression and Anxiety Screening Identifies Patients That may Benefit From Treatment Regardless of Existing Diagnoses

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