The Cost of Poor Mental Health in Total Joint Arthroplasty

• Published in: The Journal of arthroplasty Vol. 35; no. 12; pp. 3432 - 3436
• Main Authors: Ahn, Amy, Snyder, Daniel J., Keswani, Aakash, Mikhail, Christopher, Poeran, Jashvant, Moucha, Calin S., Kanabar, Megha
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2020
• Subjects: Arthroplasty, Replacement, Hip; bundled payment programs; depression; Humans; Medicare; Mental Health; New York City; Patient Care Bundles; patient reported outcomes; total joint arthroplasty; United States; New York City; United States; total joint arthroplasty; depression; patient reported outcomes; mental health; bundled payment programs
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.06.083

The purpose of this analysis was to evaluate (1) the impact of depression on resource utilization and financial outcomes in bundled total joint arthroplasty (TJA) and (2) whether similar effects are seen using baseline patient-reported outcome scores. All elective bundled TJA cases from 2017 to 2018 at an academic system in the New York City area were included. We analyzed variables associated with cost differences seen between patients with and without depression, and between patients with low (<40th percentile) and high baseline (>60th percentile) Veterans RAND 12-Item Health Survey mental component scores (MCSs). We also analyzed whether depression or low MCS could predict worse financial outcomes. Our population included 825 patients, 418 with patient-reported outcome scores data. Depression was associated with higher rates of skilled nursing facility (SNF) discharge (42.7% vs 36.5%, P = .04), SNF payments ($16,200 vs $12,100, P = .0002), and average total episode costs ($31,000 vs $27,000, P = .04). Depression predicted bundle cost to be greater than target price (OR 1.82, 95% CI: 1.04-.16; P = .04) and SNF payment greater than 75th percentile (OR: 1.91; 95% CI: 1.00-3.65; P < .05). Similar effects were not seen using MCS. This is the first study to determine that depression predicts bundle cost greater than target price and SNF payment greater than 75th percentile. Our results emphasize the importance of accurate preoperative assessment of mental health in optimization of care, focusing on attenuating the increased SNF payments associated with depression. As similar effects were not seen using MCS, future studies should analyze the use of validated screening tools for depression, such as the PHQ-9, for more accurate assessments of patient mental health in TJA.