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Published on: September 7, 2022
Association Between Comorbid Depression and Rates of Postoperative Complications, Readmissions, and Revision
Ryan D Freshman1, Madeleine Salesky1, Charles J Cogan1
1Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, California, USA.
Insights
Patients with preoperative depression face higher risks of complications, readmissions, and revision surgery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). This highlights the need for integrated mental health care in orthopedic treatment plans.
Area of Science:
- Orthopedics
- Psychiatry
- Health Services Research
Background:
- Preoperative depression is prevalent in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).
- The impact of depression on postoperative outcomes following hip arthroscopy is not well understood.
- Existing research lacks comprehensive data on depression's effect on complications, readmissions, and revision procedures.
Purpose of the Study:
- To investigate the association between preoperative depression and 90-day postoperative complications and readmissions after hip arthroscopy for FAIS.
- To determine if preoperative depression increases the risk of undergoing additional ipsilateral hip procedures post-arthroscopy.
- To compare the prevalence of preoperative depression in hip arthroscopy patients versus those undergoing shoulder or knee arthroscopy.
Main Methods:
- Retrospective cohort study utilizing the Mariner/PearlDiver database (2010-2019).
- Comparison of patients with and without preexisting depression who underwent hip arthroscopy for FAIS, matched 1:1 on key demographic and comorbidity factors.
- Analysis of Current Procedural Terminology and International Classification of Diseases codes to identify outcomes and procedures.
Main Results:
- Preoperative depression was significantly more common in hip arthroscopy patients (25.4%) compared to shoulder (22.2%) or knee (19.8%) arthroscopy patients.
- Patients with preoperative depression exhibited higher rates of 90-day readmissions (2.4% vs. 1.5%) and numerous complications, including UTI, pneumonia, hematoma, AKI, DVT/PE, and superficial infections (all P < .01).
- Preoperative depression was linked to a significantly increased likelihood of revision hip arthroscopy within 2 years (6.3% vs. 2.4%; P < .001).
Conclusions:
- Preexisting depression is associated with significantly increased rates of postoperative complications and hospital readmissions following elective hip arthroscopy for FAIS.
- Patients with preoperative depression have a higher probability of requiring revision hip arthroscopy within two years of their initial surgery.
- These findings underscore the importance of addressing preoperative depression in patients undergoing hip arthroscopy to optimize surgical outcomes and potentially reduce revision rates.
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.
