Preoperative Depression Influences Outcomes Following Total Ankle Arthroplasty

CATEGORY: Ankle; Ankle Arthritis; Other INTRODUCTION/PURPOSE: Total ankle arthroplasty (TAA) is a successful procedure and its incidence is increasing. While a diagnosis of depression is known to effect outcomes following other procedures, its effect on outcomes following TAA are unknown. Therefore, the purpose of this study was to assess the contribution of depression to outcomes following TAA. We hypothesized depression would lead to increased rates of 90-day complications. METHODS: This is a retrospective cohort study. Data was collected from the Nationwide Readmission Database (NRD) for all patients undergoing TAA. Patients were screened for a documented preoperative diagnosis of depression. Two cohorts (those with and without depression) were created. Logistic regression was then performed to assess the contribution of a pre-operative diagnosis of depression on rates of 90-day complications, while controlling for patient demographic and comorbid data. RESULTS: Overall 8,047 patients underwent TAA during the study period. Of these, 11.4% (918) had a pre-operative diagnosis of depression. Compared to patients without depression, patients with depression had a 1.61 (95% Confidence Interval [CI]: 1.31- 1.98) times increased odds of non-home discharge and a 34% increased odds (Odds ratio [OR] 1.34, 95%CI 1.15-1.57) of extended LOS (>2 days). In addition, patients were at increased risk of prosthetic complication (OR 1.39, 95%CI 1.10-1.74), wound complication (OR 1.59, 95%CI 1.11-2.29), prosthetic joint infection (OR 1.82, 95%CI 1.06-3.15), superficial surgical site infection (OR 1.62, 95%CI 1.02-2.58), and occurrence of at least one medical complication (OR 1.32, 95%CI 1.03-1.68). CONCLUSION: Depression in patients undergoing TAA is common and should be recognized by providers. Furthermore, it is associated with increased healthcare utilization and complications following surgery. Further research should be performed to determine if depression is a modifiable risk factor.