Preoperative Psychiatric Diagnosis Predicts Worse Patient-Reported Outcome Measures, Higher Dissatisfaction, and Increased Health Care Utilization Following Total Knee Arthroplasty: Analysis of Over 13,000 Patients.

BACKGROUND

This study sought to evaluate (1) clinically meaningful improvements in patient-reported outcome measures, (2) self-reported satisfaction, and (3) health care utilization among patients undergoing total knee arthroplasty (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 included anxiety, bipolar disorder, depression, posttraumatic stress disorder, psychosis, substance abuse, and "multiple diagnoses." 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. The patient-reported outcome measure scores included the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale, Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR).

RESULTS

Psychiatric disease was independently associated with failure to achieve minimal clinically important difference 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 at 1-year (P = 0.005). Also, patients who had a preoperative psychiatric diagnosis were more likely to experience a prolonged length of stay (P = 0.009), nonhome discharge (P < 0.001), and 90-day hospital readmission (P < 0.001).

CONCLUSIONS

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 health care utilization. A multidisciplinary approach to preoperative mental health optimization and postoperative surgical care may help.