Are Patients Who Have Pre-Existing Psychiatric Diagnoses Less Likely to Achieve the Centers for Medicare & Medicaid Services Defined Substantial Clinical Benefit following Total Hip and Total Knee Arthroplasty?

Abstract

Background: Psychiatric disorders affect nearly one in four adults and are associated with worse surgical outcomes. However, limited data exist on their impact on patient-reported outcome measures (PROMs) or the achievement of substantial clinical benefit (SCB), as defined by the Centers for Medicare & Medicaid Services (CMS). This study evaluated how psychiatric diagnoses influence outcomes after total joint arthroplasty (TJA), including PROMs, emergency department (ED) visits, discharge dispositions, and lengths of stay (LOS).

Methods: We conducted a retrospective cohort study of patients undergoing primary TJA from 2021 to 2023. Psychiatric diagnoses (e.g., schizophrenia, bipolar disorder, major depressive disorder [MDD], anxiety, post traumatic stress disorder, antisocial personality disorder) were identified via International Classification of Diseases (ICD)-10 codes. The primary outcome was achieving CMS-defined SCB. The secondary outcomes included 90-day ED visits, LOS, and discharge dispositions. Univariate and multivariate regression analyses assessed associations between psychiatric comorbidities and outcomes.

Results: In THA patients, psychiatric comorbidity was not associated with failure to achieve SCB (odds ratio (OR): 0.67, P = 0.6), but was linked to higher ED visit rates in MDD patients (4.3 versus 2.4%, P = 0.015), more facility-based discharges (19 versus 5.3%, P < 0.001), and longer LOS (OR: 1.96, P < 0.001). In TKA patients, psychiatric diagnoses were associated with lower odds of achieving SCB (OR: 3.06, P = 0.013), increased ED visits (6.4 versus 4.4%, P = 0.011), more facility discharges (17 versus 4.3%, P < 0.001), and prolonged LOS (OR: 2.48, P < 0.001).

Conclusions: Psychiatric comorbidities, especially in TKA, adversely affect recovery and functional outcomes after arthroplasty. Preoperative mental health screening and tailored perioperative strategies may help optimize recovery.