Mental Health (or Lack Thereof) Tanking THA Outcomes?

Is it possible to predict health care utilization rates and 1-year patient-reported outcome measures (PROMs) by looking at mental component scores in total hip arthroplasty (THA)?

“Yes,” say a group of researchers from Ohio’s Cleveland Clinic based on their new study “Preoperative Veteran RAND-12 Mental Composite Score of >60 Associated With Increased Likelihood of Patient Satisfaction After Total Hip Arthroplasty,” which appears in the December 11, 2022 edition of The Journal of Arthroplasty.

“Mental health is a widespread but often ‘invisible’ phenomenon, and as surgeons we need to raise awareness and provide tools to screen and address this need,” co-author Nicolas Piuzzi, M.D., co-director of the Musculoskeletal Research Center at Cleveland Clinic told OTW.

“Poor preoperative mental health has been associated with worse outcomes after THA. While this correlation has been widely reported, there has not been a quantitative assessment of a threshold value below which negative outcomes occur.”

The researchers collected data from a prospective cohort of 4,194 primary THA patients. The team looked specifically for associations between preoperative Veterans RAND 12-Item health survey mental component scores and postoperative outcomes, including:

• 90-day hospital resource utilization (non-home discharge, prolonged length of stay [3 days], all-cause readmission),
• attainment of patient acceptable symptom state at 1-year postoperative and
• substantial clinical benefit in the hip disability osteoarthritis outcome score (pain and physical short form).

“Overall, low preoperative Veterans RAND 12 mental component scores, specifically less than 40, were significantly associated with increased health care utilization,” said Dr. Piuzzi to OTW. “Furthermore, preoperative Veterans RAND 12 mental component scores >60 were associated with increased likelihood of overall satisfaction at 1-year as well as achieving a substantial clinical benefit in hip disability osteoarthritis outcome score hip disability osteoarthritis outcome score-joint related.”

“Also, this study identified associations between increased Veterans RAND 12 mental component values and better PROMs outcomes such as patient acceptable symptom state and substantial clinical benefit in hip disability osteoarthritis outcome score-pain.”

The researchers found that Veterans RAND 12 mental component score was positively correlated to such factors as:

• older age, obesity,
• Black race,
• women, and
• smokers.

Having a preoperative Veterans RAND 12 mental component score <20 was associated with more than twice the odds of nonhome discharge and prolonged length of stay.

A Veterans RAND 12 mental component score >60 was associated with higher odds of achieving patient acceptable symptom state and substantial clinical benefit in HOOS-joint related.

Starting with a Veterans RAND 12 mental component score ≤ 40, they found exponentially higher odds of worse outcomes.

Dr. Piuzzi: “I was surprised by finding that a readily available tool correlates that much with the outcomes assessed and it may be used to screen patients at higher risk. These quantifiable thresholds for Veterans RAND 12 mental component scores may aid in screening patients in preoperative visits for low mental health status and can prompt the health care team to identify patients at risk for poor outcomes following THA and may establish special care pathways which can improve safe and efficient delivery of care.”

“These results may encourage a broader discussion on the management of mental health status in patients undergoing THA as well as counseling in setting expectations about this procedure. Future research evaluating screening and interventions are needed. However, the main underlying problem in the field is the lack of funding to further expand upon these findings.”