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Do preoperative anxiety and depression affect quality of recovery and length of stay after hip or knee arthroplasty?

Toronto, Ontario

To the Editor:

Early detection of patients likely to suffer poor postoperative quality of recovery (QOR) and prolonged length of stay (LOS) in hospital enables prompt mobilization of support services, efficient discharge, and cost reduction. Previous studies designate advanced age and female gender as predictive of poor QOR¹ and prolonged LOS^2,3 after major orthopedic surgery. Given the prevalence and morbidity of anxiety and depression in the elderly, we considered the effect of these disorders on QOR and LOS after hip or knee arthroplasty.

We examined 38 random adult patients undergoing elective hip or knee arthroplasty. Preoperatively, patients completed the Hospital Anxiety and Depression Scale⁴ which screens for anxiety and depression and provides a measure of severity for each disorder. On the fourth postoperative day, patients completed the QOR Score¹ which yields a measure of postoperative health status including emotional state, physical independence, and pain. Bivariate correlations between preoperative variables (anxiety; depression) and postoperative outcomes (QOR; LOS) were evaluated with two-tailed tests of significance. Spearman correlation coefficients (r) were calculated for all patients in aggregate and for subgroups based on age, gender, and type of surgery.

Between increased anxiety and reduced QOR, we demonstrated a significant correlation for all patients in aggregate (r=-0.505; P=0.001), and a significant correlation for each subgroup of patients analyzed, except hip arthroplasty. For all patients in aggregate, we found no correlation between anxiety and LOS, depression and QOR, or depression and LOS.

Our preliminary results suggest an association between preoperative anxiety and poor QOR after hip or knee arthroplasty.

References

1 Myles PS, Hunt JO, Nightingale CE, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesth Analg 1999; 88: 83–90.[Abstract/Free Full Text]

2 Rissanen P, Aro S, Paavolainen P. Hospital- and patient-related characteristics determining length of hospital stay for hip and knee replacements. Int J Technol Assess Health Care 1996; 12: 325–35.[Medline]

3 Collins TC, Daley J, Henderson WH, Khuri SF. Risk factors for prolonged length of stay after major elective surgery. Ann Surg 1999; 230: 251–9.[Medline]

4 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70.[Medline]

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