Anxiety in Patients with Preexisting Depression and Anxiety Undergoing Total Hip Arthroplasty

Background: Depression and anxiety are common among patients having total hip arthroplasty (THA) and are linked to worse postoperative results. Ketamine is a dissociative anesthetic with antidepressant effects and has gained popularity as a perioperative treatment for mental conditions like major depressive disorder (MDD) and generalized anxiety disorder (GAD). Objective: To evaluate whether intraoperative ketamine administration improves short-term postoperative mental health outcomes in THA patients with preexisting MDD and/or GAD. Methodology: A retrospective cohort analysis was conducted utilizing TriNetX's Global Collaborative Network, with 152 healthcare institutions analyzed. We included adult patients (≥18 years) receiving THA with diagnoses of generalized anxiety disorder, major depressive disorder, or depressive episode. Two cohorts were formed using 1:1 propensity score matching to compare age, gender, and other characteristics. The cohorts included patients who received intraoperative ketamine (n = 21,394) as well as those who did not. Depressive and anxiety episodes, as well as psychiatric drug use, were monitored and studied throughout a 90-day postoperative period. Results: Compared to the controls, the ketamine group had a significantly higher risk of depressive episodes (24.9% vs. 20.2%; risk ratio [RR] 1.24; odds ratio [OR] 1.31; hazard ratio [HR] 1.28; p<0.0001), anxiety disorders (22.7% vs. 17.6%; RR 1.29; OR 1.37; HR 1.34; p<0.0001), and psychiatric medication use (38.6% vs. 35.8%; RR 1.08; OR 1.13; HR 1.09; p<0.0001). Conclusion: Our study showed that intraoperative ketamine was associated with higher short-term risk and earlier onset of postoperative psychiatric symptoms in patients with history of depression or anxiety undergoing THA. These findings challenge the previous literature of ketamine’s perioperative psychiatric benefit and highlight the need for further prospective studies.