Complications and Healthcare Cost of Total Hip Arthroplasty in Patients with Depressive Disorder

Area of Science:

• Orthopedic Surgery
• Psychiatric Comorbidity
• Health Services Research

Background:

• Total hip arthroplasty (THA) is a common procedure for treating femoral neck fractures (FNFs).
• The impact of depressive disorder (DD) on outcomes following THA for FNFs is not fully understood.
• Understanding these impacts is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To investigate if patients with depressive disorder (DD) have higher rates of in-hospital length of stay (LOS), readmissions, medical complications, and costs of care after primary total hip arthroplasty (THA) for femoral neck fractures (FNFs).

Main Methods:

• A retrospective analysis of a national administrative claims database from 2006 to 2014.
• Propensity score matching (1:5 ratio) was used to compare patients with DD to a control group (DD=6,758, controls=33,708).
• Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements.

Main Results:

• Patients with DD had a significantly longer LOS (5.6 vs. 5.4 days, P<0.001).
• The odds of 90-day medical complications were substantially higher for patients with DD (60.6% vs. 21.4%, OR 1.57, P<0.0001).
• Patients with DD incurred significantly higher healthcare expenditures within 90 days ($21,382 vs. $19,781, P<0.001).
• Readmission rates were similar between groups (29.9% vs. 25.0%, P=0.281).

Conclusions:

• Depressive disorder is associated with longer LOS, increased 90-day medical complications, and higher healthcare costs following THA for FNFs.
• These findings underscore the importance of addressing mental health in orthopedic surgical care.
• Pre-operative counseling for patients with DD undergoing THA is recommended to manage expectations and optimize outcomes.