Depression and anxiety are associated with worse baseline function in hip arthroscopy patients

Abstract

Purpose The purpose of this study was to analyze the correlation between baseline depression and anxiety and preoperative functional status in hip arthroscopy patients. Methods A prospective, institutional review board-approved orthopaedic registry was used to retrospectively study 104 patients undergoing hip arthroscopy. Enrolled patients were administered baseline questionnaires for Patient-Reported Outcomes Measurement Information System (PROMIS) domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) preoperative expectations, and Numeric Pain Scale (NPS). ResultsThe average baseline PROMIS Depression and Anxiety scores were 49.9 ± 9.8 and 55.5 ± 9.3, respectively. Bivariate analysis demonstrated that greater baseline PROMIS Anxiety correlated with worse preoperative PROMIS PI (p < 0.001), Fatigue (p < 0.001), Social Satisfaction (p < 0.001), and NPS score (p = 0.013). Bivariate analysis showed that greater PROMIS Depression correlated with worse preoperative PROMIS PF (p = 0.001), PI (p < 0.001), Fatigue (p < 0.001), SS (p < 0.001), and NPS score (p = 0.004). After controlling for confounders, multivariable analysis conirmed increased PROMIS Depression as an independent predictor of worse preoperative PROMIS PF (p = 0.009), MODEMS Expectations (p = 0.025), and NPS score (p = 0.002). Increased PROMIS Anxiety was predictive of worse baseline PROMIS PI (p < 0.001), Fatigue (p < 0.001), and Social Satisfaction (p < 0.001). A previous clinical diagnosis of depression or anxiety was only an independent predictor of worse baseline PROMIS Fatigue (p = 0.002) and was insigniicant in all other models. Conclusion Increasing severity of depression and anxiety correlated with and predicted worse functional status at baseline in hip arthroscopy patients. As compared to clinical diagnosis of anxiety and depression, PROMIS metrics have superior utility in recognizing potentially modiiable mental health concerns that predict worse preoperative status. Ultimately, the study identiies an at-risk population undergoing hip arthroscopy that requires particular attention and potential mental health intervention in the preoperative setting. Level of evidence III.

Effects of Preexisting Anxiety and Depression on Postoperative Outcomes in Patients Aged 30 Years and Younger Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome

“…In this study, we also demonstrated an association between postoperative complications, including postoperative ipsilateral hip injection, any reoperation and revision hip arthroscopy, and a diagnosis of depression, anxiety, or both, which is consistent with previously published results [8,12]. Unlike other published studies, we did not find significant differences in PROMs between patients with a diagnosis of depression and/or anxiety, and those without these diagnoses, although only a very small subset of patients in this study had PROMs on record [15,32].…”

“…However, given the significant variability in depression and anxiety symptoms and presentation, which vary by sex and age, recognition of previously undiagnosed but clinically relevant pathology can be extremely challenging for orthopedic surgeons [6,13,29]. We therefore advocate for the integration of validated instruments such as PROMIS Anxiety and Depression scales to screen for depression and anxiety in the orthopedic practice setting [15]. This will allow for the identification of patients who may benefit from referral to additional resources.…”

Social Determinants of Health in Maryland Hip Arthroscopy Patients

“…Psychosocial factors such as depression and anxiety have shown associations with worse baseline function and poorer outcomes post-surgery [ 25 ]. Patients with symptoms of depression have consistently reported lower initial functional scores, higher pain levels, and reduced satisfaction following HA [ 26 ].…”