The Impact of Intraoperative Ketamine on Postoperative Depression and Anxiety in Patients with Preexisting Depression and Anxiety Undergoing Total Hip Arthroplasty

Background: Depression and anxiety are common among patients having total hip arthroplasty (THA) and are linked to worse postoperative results. Ketamine is a dissociative anesthetic with antidepressant effects and has gained popularity as a perioperative treatment for mental conditions like major depressive disorder (MDD) and generalized anxiety disorder (GAD). Objective: To evaluate whether intraoperative ketamine administration improves short-term postoperative mental health outcomes in THA patients with preexisting MDD and/or GAD. Methodology: A retrospective cohort analysis was conducted utilizing TriNetX’s Global Collaborative Network, with 152 healthcare institutions analyzed. We included adult patients (≥18 years) receiving THA with diagnoses of generalized anxiety disorder, major depressive disorder, or depressive episode. Two cohorts were formed using 1:1 propensity score matching to compare age, gender, and other characteristics. The cohorts included patients who received intraoperative ketamine (n = 21,394) as well as those who did not. Depressive and anxiety episodes, as well as psychiatric drug use, were monitored and studied throughout a 90-day postoperative period. Results: Compared to the controls, the ketamine group had a significantly higher risk of depressive episodes (24.9% vs. 20.2%; risk ratio [RR] 1.24; odds ratio [OR] 1.31; hazard ratio [HR] 1.28; p<0.0001), anxiety disorders (22.7% vs. 17.6%; RR 1.29; OR 1.37; HR 1.34; p<0.0001), and psychiatric medication use (38.6% vs. 35.8%; RR 1.08; OR 1.13; HR 1.09; p<0.0001). Conclusion: Our study showed that intraoperative ketamine was associated with a higher short-term risk and earlier onset of postoperative psychiatric symptoms in patients with a history of depression or anxiety undergoing THA. These findings challenge the previous literature on ketamine’s perioperative psychiatric benefits and highlight the need for further prospective studies.