JOA - 2026-06-01 - Journal Article; Multicenter Study
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?
McKegg PC, Hodson NM, Zamzam ME, Driessche AM, North WT, Charters MA
Topics
Key Takeaway
Psychiatric comorbidity in TKA patients is associated with 3.06-fold higher odds of failing to achieve CMS-defined substantial clinical benefit, while THA patients show no significant SCB difference despite worse utilization metrics.
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Summary
This multicenter retrospective cohort study evaluated whether pre-existing psychiatric diagnoses (schizophrenia, bipolar disorder, MDD, anxiety, PTSD, antisocial personality disorder) impair achievement of CMS-defined SCB and affect utilization outcomes after primary THA and TKA. In TKA, psychiatric comorbidity was independently associated with failure to achieve SCB (OR 3.06, P=0.013), increased 90-day ED visits (6.4 vs 4.4%), more facility-based discharges (17 vs 4.3%), and longer LOS (OR 2.48). In THA, psychiatric diagnoses did not significantly affect SCB (OR 0.67, P=0.6) but were associated with higher facility discharge rates and prolonged LOS, with MDD specifically driving higher ED visit rates (4.3 vs 2.4%).
Key Limitation
The total sample size is unreported, and psychiatric diagnoses were identified solely by ICD-10 coding without verification of active treatment status or severity, introducing significant misclassification bias.
Original 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. This study evaluated how psychiatric diagnoses influence outcomes after total joint arthroplasty, including patient-reported outcome measures, emergency department (ED) visits, discharge dispositions, and lengths of stay (LOS).
METHODS
We conducted a retrospective cohort study of patients undergoing primary total joint arthroplasty from 2021 to 2023. Psychiatric diagnoses (e.g., schizophrenia, bipolar disorder, major depressive disorder, anxiety, post-traumatic stress disorder, antisocial personality disorder) were identified via International Classification of Diseases, Tenth Revision codes. The primary outcome was achieving Centers for Medicare & Medicaid Services-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 total hip arthroplasty 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 major depressive disorder 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.