A Nationwide Analysis Shows Anxiety Disorders Are Associated With Higher Rates of Pneumonia, Pulmonary Embolism, Deep Vein Thrombosis, and Acute Renal Failure After Hip Arthroscopy for Femoral Acetabular Impingement Syndrome: A Matched-Control Analysis.

Abstract

Purpose: To use a nationwide administrative database (PearlDiver) to investigate whether patients with generalized anxiety disorder (GAD) undergoing primary hip arthroscopy for femoral acetabular impingement syndrome (FAIS) have (1) higher rates of medical complications, (2) higher readmission rates, and (3) higher costs of care as compared with patients without GAD.

Methods: Using the PearlDiver database, we performed a retrospective query from January 1, 2010, to March 31, 2020, to include all patients who underwent hip arthroscopy for FAIS. From this base population, patients with a diagnosis of GAD were identified and designated as the study group. The study group was matched at a 1:5 ratio by age, sex, and multiple comorbidities (depression, hypertension, diabetes mellitus, and tobacco use) to a control group of patients without GAD who underwent hip arthroscopy for FAIS. The primary outcomes analyzed included 90-day medical complications, 90-day readmission rates, and 90-day costs of care. χ² Analyses were used to compare patient demographic characteristics. Logistic regression analyses were used to calculate odds ratios (ORs) of medical complications and readmissions. The Welch t test was used to compare costs. Bonferroni correction was performed to reduce the probability of a type I error. This was achieved by taking the standard P value of .05 and dividing it by the total number of dependent variables analyzed in the study. As such, P < .005 was considered statistically significant.

Results: The query yielded 7,631 patients with GAD undergoing hip arthroscopy for FAIS. These patients were compared with 38,145 matched controls without GAD. Patients with anxiety were at significantly higher risk of postsurgical complications, with the highest risks observed for pneumonia (1.0% vs 0.4%; OR, 2.57; 95% confidence interval [CI], 1.97-3.35; P = .004) and deep vein thrombosis (0.36% vs 0.15%; OR, 2.42; 95% CI, 1.52-3.76; P = .002). Other significant risks included acute renal failure (0.46% vs 0.21%; OR, 2.13; 95% CI, 1.42-3.15; P = .002) and pulmonary embolism (0.21% vs 0.13%; OR, 1.66; 95% CI, 0.92-2.87; P = .001). There was no statistically significant difference in readmission rates within 90 days (1.46% vs 1.24%; OR, 2.38; 95% CI, 2.13-2.67; P = .02) or 90-day total costs of care ($4,812 ± $1,292 vs $4,076 ± $1,179; P = .73) between the 2 groups.

Conclusions: After adjusting for age, sex, and medical comorbidities, this study found that GAD was associated with significantly higher rates of pneumonia, deep vein thrombosis, acute renal failure, and pulmonary embolism after hip arthroscopy for FAIS. There were no significant differences in 90-day readmission rates or 90-day total costs of care. Considering the relatively high prevalence of anxiety and the increasing rate of hip arthroscopy, preoperative screening for anxiety may help surgeons identify and protect patients at increased risk of complications after hip arthroscopy.

Level of evidence: Level III, retrospective, comparative case-control study.