Association of Depression With 90-Day Hospital Readmission After Total Joint Arthroplasty

• Published in: The Journal of arthroplasty 2016-11, Vol.31 (11), p.2385-2388
• Main Authors: Gold, Heather T., PhD, Slover, James D., MD, MS, Joo, Lijin, BA, Bosco, Joseph, MD, Iorio, Richard, MD, Oh, Cheongeun, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - psychology; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - psychology; California; Depression; Female; health care economics; hospital readmission; Humans; Logistic Models; Male; Medicaid; Middle Aged; Odds Ratio; Orthopedic Procedures; Orthopedics; Patient Readmission - statistics & numerical data; psychiatric conditions; Retrospective Studies; total hip arthroplasty; total knee arthroplasty; United States
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.04.010

Abstract Background Hospital readmission after total joint arthroplasty accounts for substantial resource consumption. Depression has been shown to impact postsurgical outcomes. We therefore aimed to study the association of depression with risk of readmission after total joint arthroplasty. Methods Retrospective cohort data from the population-based California Healthcare Cost and Utilization Project database from 2007 to 2010 were analyzed using multivariable logistic regression to predict odds of 90-day readmission after hospital discharge for primary total knee arthroplasty (TKA, n = 132,422) or total hip arthroplasty (THA, n = 65,071) arthroplasty in adults ages 50+ years. We included the primary exposure of depression and controlled for age, sex, race/ethnicity, Medicaid insurance, comorbidities, and admission year. Results Overall 90-day readmission rates were approximately 8% for TKA and THA. Even after controlling for other chronic conditions and nonmodifiable covariates, we found depression predicted higher likelihood of readmission. The odds of readmission for subjects with depression were 21%-24% higher overall (odds ratio for TKA: 1.21, 95% confidence interval: 1.13-1.29; odds ratio for THR: 1.24, 95% confidence interval: 1.13-1.35; P < .001). Subjects with surgery in earlier years were also more likely to be readmitted ( P < .01). Conclusion Depression is associated with a significantly higher risk of readmission after THA and TKA. Hospital readmissions must be minimized to improve care quality, while making these procedures fiscally feasible. Promoting care coordination across disciplines for management of nonorthopedic comorbidities before surgery, particularly in higher risk patients with depression, could optimize orthopedic surgery outcomes, patient well-being, and costs of care. Therefore, every effort to address depression before surgery is warranted.