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

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). 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. 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). 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.