Preoperative Depression Influences Outcomes Following Total Ankle Arthroplasty

Abstract

Introduction Total ankle arthroplasty (TAA) is increasing in incidence. While preoperative depression is known to affect outcomes following other procedures, its effect on outcomes following TAA are unknown. Therefore, the purpose of this study was to investigate this relationship. Methods This is a retrospective cohort study using the Nationwide Readmission Database (NRD). All patients undergoing TAA were included. Two cohorts (those with and without preoperative depression) were created. Logistic regression was then performed to assess the contribution of a preoperative diagnosis of depression on rates of 90-day complications, while controlling for patient demographic and comorbid data. Results Overall, 8047 patients were included, of whom, 11.4% (918) were depressed. Compared to patients without depression, patients with depression had increased odds of the following: nonhome discharge (OR 1.61, 95% CI 1.31-1.98), extended length of stay (>2 days; OR 1.34, 95% CI 1.15-1.57), prosthetic complication (OR 1.39, 95% CI 1.10-1.74), wound complication (OR 1.59, 95% CI 1.11-2.29), prosthetic joint infection (OR 1.82, 95% CI 1.06-3.15), superficial surgical site infection (OR 1.62, 95% CI 1.02-2.58), and medical complication (OR 1.32, 95% CI 1.03-1.68). Discussion Depression in patients undergoing TAA is common and is associated with increased health care utilization and complications following surgery. The modifiability of depression should be investigated with future studies. Levels of Evidence: Prognostic, Level III: Comparative study

The Impacts of Anxiety and Depression on Outcomes in Foot and Ankle Surgery

“…A large study of 8047 patients found that patients with depression who underwent TAA had significantly higher rates of nonhome discharge, extended length of stay, prosthetic complication, wound complication, prosthetic and superficial infections, and medical complications following TAA than patients without comorbid depression. 72 On the contrary, a broader analysis of TAA complications analyzed a wide range of comorbidities, including depression and found that depression was not associated with a greater risk of postoperative complications. 18 Although this study's sample size was smaller, it was still sizable (n = 1024), and the proportion of depressed patients was a predictable 22%.…”

Does Mental Health impact the outcomes of Total Ankle Arthroplasty? A Systematic Review

“…All the necessary data were retrieved from the studies that ascertained the correlation between mental health disorders and postoperative outcomes and complications. Three of the included studies were prospective studies [22][23][24] and the other four were retrospective studies [25][26][27][28] . The level of evidence (II and III) was reported for the included studies.…”

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

“…Prior research has shown inferior outcomes in depressed patients, but these efforts have focused mainly on other areas of orthopedics (mainly arthroplasty) as well as general surgery. 12 , 20 , 21 To our knowledge, no study has assessed preoperative depressive disorders and its associated postoperative complications in patients undergoing hip fracture fixation. The purpose of this study was to further understand the effects of pre-operative depression in patients who undergo intertrochanteric fracture fixation.…”

“…Given that the prevalence of depression within the United States is roughly 20 million Americans according to the World Health Organization 10 and the existence of prior literature showing unfavorable clinical outcomes in patients with preoperative diagnosis of depression, 11 - 13 there remains a need to study this topic in patients with hip fractures. The purpose for this investigation was to analyze the effects a preoperative diagnosis of depression on complications following hip fracture fixation in the geriatric population using a large national insurance claims database.…”

“…In the adult reconstruction and foot and ankle literature, preoperative depression in patients undergoing total hip and knee arthroplasty, revision hip and knee arthroplasty, and total ankle arthroplasty has been found to be associated with increased risk of complication and increased healthcare resource utilization. 9 Given that the prevalence of depression within the United States is roughly 20 million Americans according to the World Health Organization 10 and the existence of prior literature showing unfavorable clinical outcomes in patients with preoperative diagnosis of depression, [11][12][13] there remains a need to study this topic in patients with hip fractures. The purpose for this investigation was to analyze the effects a preoperative diagnosis of depression on complications following hip fracture fixation in the geriatric population using a large national insurance claims database.…”