title: Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study.
abstract: BACKGROUND
  Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about their impact on outcomes in the perioperative setting. This study is intended to gain insight into epidemiology and effects on perioperative morbidity, mortality, length of hospital stay, discharge and cost.
  
  
  METHODS
  We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. Entries indicating the performance of primary total hip and knee arthroplasty were identified and separated into four groups: (1) those with concomitant diagnosis of depression or (2) anxiety, (3) both, and (4) none of these diagnoses. The incidence of major complications, non-routine discharge, length, and cost of hospitalization were assessed. Regression analysis was performed to identify if psychiatric comorbidity was an independent risk factor for each outcome.
  
  
  RESULTS
  We identified 1,212,493 patients undergoing arthroplasty between 2000 and 2008. The prevalence of depression and anxiety significantly increased over time. Patients with either condition had higher hospital charges, rates of non-routine discharges and comorbidity index. Depression or anxiety were associated with significantly decreased adjusted odds for in-hospital mortality (OR = 0.53, p = 0.0147; OR = 0.58, p = 0.0064). The risk of developing a major complication was slightly lower in patients with depression, anxiety or both (OR=0.95, p = 0.0738; OR = 0.95, p = 0.0259; OR = 0.94, p = 0.7349).
  
  
  CONCLUSIONS
  Patients suffering from depression, anxiety, or both require more healthcare resources in a perioperative setting. However, lower short-term mortality in spite of higher comorbidity burden and without extensive changes in perioperative complication profile indicates better outcome for this group of patients.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Ottokar
authors.initials: O
authors.lastname: Stundner
authors.forename: Meghan
authors.initials: M
authors.lastname: Kirksey
authors.forename: Ya Lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
authors.forename: Lazaros
authors.initials: L
authors.lastname: Poultsides
authors.forename: Peter
authors.initials: P
authors.lastname: Gerner
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000191:economics / Q000453:epidemiology*; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D003710:Demography; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D059035:Perioperative Period / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology