Examining the Influence of Psychiatric Comorbidities on Postoperative Outcomes in Total Ankle Arthroplasty

Category: Ankle; Ankle Arthritis Introduction/Purpose: Historically, a robust association between psychiatric conditions and perioperative complications following orthopaedic surgeries has been established. Within the past decade, the prevalence of total ankle arthroplasty (TAA) has risen by 136.1%. In a similar time frame, the United States has seen the prevalence of mental health disorders rise, a trend that was accentuated by the COVID-19 pandemic. This study aims to evaluate the effect of mental health disorders on the postoperative outcomes of patients undergoing primary TAA. Methods: The Nationwide Readmissions Database (NRD) was queried to identify 29,705 patients undergoing primary TAA from 2015 to 2020. Patients were then divided into cohorts based on concurrent mental health diagnosis (MHD) (MHD=6,041, no MHD=23,664). Further analysis was performed for common mental health diagnoses, including depression (n=3,553), anxiety (n=3,510), psychosis (n=592), bipolar disorder (BPD) (n=411), and post-traumatic stress disorder (PTSD) (n=235). A multivariate regression analysis was performed to control for confounding variables. Results: Patients with any MHD were significantly younger (p <.001), more likely to be female (p <.001), lower income (p <.001), and had a higher Charlson-Deyo Comorbidity Index (p <.001). These patients were also significantly more likely to have Medicaid insurance (p <.001) and be treated at an urban teaching hospital (p=.027). Patients with anxiety, depression, or psychosis experienced statistically significantly higher rates of complications. Similarly, patients with anxiety, psychosis, or PTSD experienced statistically significantly higher rates of postoperative deep infections. Multivariate regression analysis found any MHD to be predictive of increased risk of complication by 16% (OR=1.158; 95%CI=1.048-1.278; p=.004), adverse discharge by 70% (OR=1.678; 95%CI=1.57-1.793; p<.001), extended stay by 50% (OR=1.497; 95%CI=1.351-1.658; p<.001), and infection by 65% (OR=1.654; 95%CI=1.231-12.223; p<.001). Conclusion: Patients with MHD are at a statically significantly higher risk of complications, infections, protracted hospital stays, and adverse discharge outcomes following primary TAA. Careful appraisal and counseling are necessary in this patient demographic when considering patients selection for TAA.