Anxiety and depression are associated with increased complication risk after total elbow arthroplasty: A matched cohort study

Background The purpose of this study is to investigate 90-day and two-year outcomes of total elbow arthroplasty (TEA) in patients diagnosed with anxiety and depression. Methods A retrospective cohort study was conducted to identify adults undergoing TEA between 2003 and 2023 with a minimum of two years of follow-up. Patients were stratified into cohorts based on diagnoses of anxiety and depression, with subanalyses conducted for each disorder compared to matched controls. Outcomes between patients with depression and anxiety versus controls, and between combined and single psychiatric diagnosis were evaluated. Results After matching, 2106 patients were included in each cohort. Patients with combined anxiety and depression had significantly higher 90-day rates of wound complications (RR 2.15, p = 0.003), anemia (RR 2.41, p = 0.002), emergency department visits (RR 1.82, p = 0.042), and readmission (RR 1.81, p = 0.005) compared to controls. At two years, this cohort also demonstrated increased risks of mechanical loosening (RR 2.25, p < 0.001) and dislocation (RR 2.11, p = 0.035). Conclusions Patients diagnosed with anxiety and depression undergoing TEA experience significantly higher short- and long-term complications compared to controls. Level of Evidence Level III; retrospective cohort.