The Effect of Depression on Total Knee Arthroplasty

Abstract

Introduction: Depression is among the most common mental illnesses, with an estimated 8.1% of adults in the United States living with the condition. Despite its prevalence, the effect of depression on surgical outcomes is not well studied. The aim of this study is to assess the effect of diagnosed major depressive disorder on postoperative outcomes following total knee arthroplasty (TKA).

Methods: This retrospective cohort study used the National Readmissions Database from 2016 to 2019 to evaluate the effect of depression on 30-day outcomes following TKA. Patients with and without a diagnosis of depression were identified using International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10) codes. Propensity score matching was employed to balance patient demographics, socioeconomic status, and comorbidities, between the two groups. Multivariate regression analyses were used to assess postoperative outcomes, 30-day readmission, and revision surgery rates.

Results: Overall, 1,906,980 patients undergoing TKA, 302,853 (15.68%) with a diagnosis of depression, were included in our analysis. After matching, those with depression were more likely to have both medical (odds ratio [OR] 1.90; P < 0.001) and surgical complications (OR 1.86; P < 0.001), including periprosthetic fracture (OR 2.27; P < 0.001). In addition, they had increased odds of 30-day readmission (OR 1.98; P < 0.001) and revision surgery (OR 1.83; P < 0.001).

Conclusion: Depression is common in the TKA population, with 15.9% of patients having a diagnosis at the time of surgery. Furthermore, these patients experience a greater risk of complications following surgery. They are also at greater risk of requiring readmission or revision surgery. Overall, patients with depression may experience worse outcomes following TKA.

Study design: Level III; Retrospective Cohort Study.