The Effect of Depression on Patient-Reported Outcomes After Total Joint Arthroplasty Is Modulated by Baseline Mental Health

Halawi, Mohamad J.; Cote, Mark P.; Singh, Hardeep; O’Sullivan, Michael; Savoy, Lawrence; Lieberman, Jay R.; Williams, Vincent

doi:10.2106/jbjs.17.01677

Cited by 49 publications

(33 citation statements)

References 25 publications

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“…Better metrics and outcomes are also needed to determine how active a particular psychiatric disorder may be at the time of surgery. Halawi et al 13 completed a prospective study to determine whether baseline mental health affected outcomes in patients with depression who were undergoing TJA. He found that patients with depression had significant improvements in outcome post-operatively, but these gains were modulated strongly by mental health at the time of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

et al. 2021

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Introduction: The purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty. Methods: Patients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination. Results: Total number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups. Conclusion: Patients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

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Section: Discussionmentioning

confidence: 99%

Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

et al. 2021

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“…Patients with diagnoses of depression, anxiety or depression and anxiety have been shown to have inferior outcomes [ 5 , 28 , 29 ]. In terms of depression alone, studies estimated a prevalence of 22%-28% in the TJA population [ 4 , 30 ]. These patients have an increased risk of readmission [ 21 , 22 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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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“…This notion was recently demonstrated in THA and TKA patients by Halawi et al, who showed that poor baseline mental health as measured by SF-36 MCS scores was a more significant negative prognostic indicator than a diagnosis of depression itself. 9 It is important to note that a diagnosis of depression in our study was obtained via chart review and does not identify whether the depression is treated. Treatment of depression may potentially lessen the effect of the diagnosis on SF-36 MCS scores and TAA outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics of Possible Responders and Nonresponders to Total Ankle Arthroplasty

et al. 2020

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Background: Characteristics of responders, or those who achieve a clinical improvement above the level of a minimal clinically important difference, have not been defined for total ankle arthroplasty (TAA). The purpose of this study was to determine patient characteristics that distinguish possible responders from possible nonresponders after TAA using criteria established for other arthroplasty surgeries. Methods: Patients undergoing TAA who were enrolled into a prospective study at a single academic center evaluating patient-reported outcomes were included. Patients were characterized as possible responders if the relative or absolute improvement in their 2-year follow-up Short Musculoskeletal Function Assessment (SMFA) function score was at least 50% or 20, respectively, compared with their preoperative score, consistent with Outcome Measures in Rheumatoid Arthritis Clinical Trials and the Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Patient factors were then associated with possible responder or nonresponder status and a multivariable analysis was performed. A total of 491 patients with complete data and 2-year follow-up were included in this study. Results: Multivariable analysis demonstrated that a higher baseline 36-Item Short-Form Survey (SF-36) mental component summary (MCS) score (OR [95% CI], 1.02 [1.01, 1.04]; P = .003), indicating better mental health, was associated with being a possible responder to TAA. The presence of rheumatic disease (OR [95% CI], 0.38 [0.22, 0.67]; P = .001) was a significant predictor of being a possible nonresponder. Conclusion: Our data reveal that a higher baseline SF-36 MCS score was associated with increased improvement in SMFA function scores, while rheumatic disease was associated with worse improvement in SMFA function scores after TAA. Patients with rheumatic disease or poor mental health may not achieve as favorable results after TAA and should be counseled appropriately. Level of Evidence: Level III, retrospective comparative study.

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The Effect of Depression on Patient-Reported Outcomes After Total Joint Arthroplasty Is Modulated by Baseline Mental Health

Cited by 49 publications

References 25 publications

Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

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

Patient Characteristics of Possible Responders and Nonresponders to Total Ankle Arthroplasty

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