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J Arthroplasty. 2014 Mar;29(3):481-3. doi: 10.1016/j.arth.2013.08.025. Epub 2013 Oct 3.

Depression is associated with early postoperative outcomes following total joint arthroplasty: a nationwide database study.

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Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.


The purpose of this study was to assess the incidence of the diagnosis of depression and determine the impact of this diagnosis on early postoperative outcomes following total joint arthroplasty (TJA). Multivariate analysis of the Nationwide Inpatient Sample database was used to compare the association of depression with inhospital morbidity, mortality, length of stay, and hospital charges following TJA. The rate of diagnosis of depression in the arthroplasty population was 10.0%. Patients with depression were significantly more likely to be white, female, and have Medicaid as a primary payer (all P<0.05). Depression was associated with a greater risk of post-operative psychosis (OR = 1.74), anemia (OR = 1.14), infection (OR = 1.33), and pulmonary embolism (OR 1.20), and a lower risk of cardiac (OR = 0.93) and gastrointestinal complications (OR = 0.80). Depression was not associated with in-hospital mortality. Depression appears to impact early postoperative morbidity after TJA, a finding which is important for patient counseling and risk adjustment.


depression; mental health; outcomes; total joint arthroplasty

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