Generalized anxiety disorder may lead to increased healthcare utilization following total hip arthroplasty

Abstract Background Psychiatric comorbidities are increasingly recognized as modifiers of arthroplasty outcomes. However, the effect of generalized anxiety disorder (GAD) on outcomes following total hip arthroplasty (THA) remains underexplored. Methods A retrospective cohort study was conducted using the PearlDiver national database to identify patients who underwent primary, unilateral THA for osteoarthritis between 2010 and 2022. Patients with <90-day follow-up were excluded. Among 278,655 eligible patients, 17,422 (6.2%) had a preoperative diagnosis of GAD. These patients were propensity score-matched 1:1 (caliper 0.2) to patients without GAD, resulting in 34,844 matched THAs. Primary outcomes included 90-day emergency department (ED) visits, readmissions, reoperations, periprosthetic joint infection (PJI) at 90 days, 1 and 2 years, and revision procedures at 1 and 2 years. Annual trends in GAD prevalence among THA patients were also analyzed. Results GAD was associated with significantly increased odds of 90-day ED visits (adjusted odds ratio [AOR], 1.21; 95% CI, 1.13–1.29; P <0.001) and 90-day reoperations (AOR, 1.20; 95% CI, 1.05–1.37; P =0.006). No differences were observed in readmissions, PJI, or revision rates at any time point. GAD prevalence among THA patients rose from 0.54% in 2010 to 10.14% in 2022—a 19-fold increase ( R 2 =0.99, P <0.001). Conclusion Preoperative GAD is associated with higher risk of 90-day ED visits and reoperations following THA. The rising prevalence of GAD suggests that preoperative mental health status may be relevant to perioperative risk stratification and supports further study of targeted optimization strategies in patients undergoing THA.