J Arthroplasty. 2025 Sep 17:S0883-5403(25)01168-4. doi: 10.1016/j.arth.2025.09.015. Online ahead of print.
ABSTRACT
INTRODUCTION: This study sought to evaluate (1) clinically meaningful improvements in patient-reported outcome measures (PROMs), (2) self-reported satisfaction, and (3) healthcare utilization metrics, including length of stay, discharge disposition, and 90-day readmission, among patients undergoing TKA with and without a preoperative psychiatric diagnosis.
METHODS: Patients undergoing elective primary, unilateral TKA at a single tertiary academic medical center in the United States between 2016 and 2022 were included. Preoperative psychiatric diagnoses were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes and included anxiety, bipolar disorder, depression, posttraumatic stress disorder, psychosis, substance abuse, and “multiple diagnoses.” The PROM scores were obtained before surgery and at one-year follow-up and included the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain Subscale (KOOS-Pain), Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR). Clinically meaningful improvements in PROM scores were determined using the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds in the literature. A total of 13,894 patients who had 14,900 TKAs were included in the study. There were 3,830 patients (28%) who had a preoperative psychiatric diagnosis.
RESULTS: After adjusting for confounding variables, psychiatric disease was independently associated with failure to achieve MCID in KOOS-PS (P = 0.016), as well as failure to achieve PASS in KOOS-pain (P = 0.016), KOOS-PS (P = 0.014), and KOOS-JR (P = 0.002). Subgroup analysis demonstrated that patients who had multiple psychiatric diagnoses had even higher odds of failing to achieve PASS for KOOS-JR (P = 0.001). Patients who had mental health conditions were also 19% less likely to be satisfied one year after surgery (P = 0.005). Also, patients who had a preoperative psychiatric diagnosis were more likely to experience a prolonged length of stay (LOS) (P = 0.009), non-home discharge (P < 0.001), and 90-day hospital readmission (P < 0.001).
CONCLUSION: Over a quarter of individuals undergoing TKA have a preexisting mental health condition. Psychiatric disease was an independent predictor of failure to achieve clinically meaningful improvements in knee pain, function, and satisfaction after surgery and was significantly associated with increased healthcare utilization. A multidisciplinary approach to preoperative mental health optimization and postoperative surgical care may help improve TKA outcomes and resource utilization for this key patient population.
PMID:40972987 | DOI:10.1016/j.arth.2025.09.015
Recent Comments