IOA 2022

Preoperative Depression is Associated with Inferior Outcomes following Total Knee Arthroplasty

Connor Byrne Caleb Durst Kevin Rezzadeh Zachary Rockov Karma McKelvy Andrew Spitzer Sean Rajaee
Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, USA

Introduction:
Preexisting depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures which quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS depression scores would be associated with inferior outcomes following TKA.

Methods:
269 patients from a single institution underwent primary TKA by three fellowship-trained arthroplasty surgeons between June 2018 and August 2020. PROMIS scores were collected preoperatively and at 6 weeks, 3 months, 1 and 2 years postoperatively. Patients with preoperative PROMIS depression scores ≥55 were considered depressed. The primary outcome measures were changes in PROMIS scores over time. Secondary outcomes were inpatient total (TME) and daily mean morphine equivalent (MME) during admission, 90-day hospital readmissions, and revisions within two years.

Results:
68 patients had preoperative PROMIS depression scores >55 (Depressed) and 201 patients were not depressed (ND). Depressed patients were significantly younger than ND, (66.4 vs 69.1; p = 0.04), used numerically more TMEs (220.9 vs 177.0, p = 0.132) and MMEs (83.5 vs 71.1, p = 0.367), had lower preoperative physical function (p < 0.001) and higher preoperative pain (p = 0.114) [Figure 1]. Depressed patients had significantly improved PROMIS depression scores at all follow-up intervals (p < 0.05), and pain scores at six weeks (p = 0.045) and one year (p = 0.016). 90-day readmissions were significantly higher in the Depressed group (14.7% vs 2.5%, p < 0.001), and revision rates were numerically higher. (4.4% vs 2.0%, p = 0.374).

Discussion:
 Preoperative PROMIS depression scores > 55 do not negatively impact postoperative function, depression, or pain following TKA, and these patients have greater improvement in depression and pain at certain intervals. However, depressed patients had substantially higher readmission and revision rates. The modifiability of this risk factor for postoperative complication is currently unknown.