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

Abstract

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.

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

“…Beyond inferior patient-reported outcomes, patients with depression or anxiety who underwent orthopaedic surgeries also had higher rates of hospital readmissions and surgical complications. 23,26,40 They were also more likely to require revision surgery. 23 Because of these readmissions, complications, and revisions, patients with depression and anxiety exhibit increased health care utilization, resulting in greater costs.…”

“…Depression and anxiety have been well-studied as factors that negatively predict the degree of surgical success in orthopaedics; however, investigations into the impacts of depression and anxiety in foot and ankle surgery are fewer and more recent than investigations focusing on other anatomical areas. Mental health disorders have been demonstrated to negatively affect surgical outcomes for a wide range of orthopaedic surgeries, including total hip and knee arthroplasties, 2,26,27,30,35,38,40,51,66,74 hip arthroscopy, 23,37,48,63,64 shoulder and elbow surgery, 43,67,71 and spine surgery. 10,47,62 The contributions of depression and anxiety to foot and ankle pain and the success of foot and ankle surgery have been more properly investigated in the past 5 years; however, they have not yet been summarized and critically analyzed in a review of the literature.…”

Impact of post-discharge phone calls on non-urgent hospital returns < 90 days following primary bariatric surgery

“…Kalogianni et al demonstrated that, in patients undergoing elective cardiac surgery, preoperative education delivered by nurses reduced anxiety and post-operative complications of patients, but it was not effective in reducing readmissions [ 23 ]. Given anxiety has been shown to undermine the influence of discharge planning in transplant patients [ 24 ], and patients with anxiety requiring medication has been shown to be significantly associated with increased rates of readmission in the orthopedic population [ 25 ], anxiety itself may mitigate any gain associated with Ph DC , and addressing anxiety as part of discharge care planning may be a first step to decreasing readmissions.…”

“…Specifically, Amiri [23]. Given anxiety has been shown to undermine the influence of discharge planning in transplant patients [24], and patients with anxiety requiring medication has been shown to be significantly associated with increased rates of readmission in the orthopedic population [25], anxiety itself may mitigate any gain associated with Ph DC , and addressing anxiety as part of discharge care planning may be a first step to decreasing readmissions.…”

Depression and anxiety are associated with an increased risk of infection, revision, and reoperation following total hip or knee arthroplasty

“…[1][2][3] Mental and social health factors have been identified as potential contributors to persistent pain, dissatisfaction, and complication rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA). [4][5][6][7][8] Previous investigations have suggested that up to 20% of patients are dissatisfied following primary TKA. 9 Depressive and anxiety disorders may also adversely affect satisfaction after THA and TKA.…”