Does enhanced recovery after surgery affect pain catastrophizing, depression, and anxiety in patients undergoing primary total hip arthroplasty?

Purpose The incidence of pain catastrophizing, depression and anxiety is not uncommon in patients undergoing primary total hip arthroplasty (THA), and Enhanced recovery after surgery (ERAS) schemes can improve peri-operative stress responses of the patients. The aim of this study is to to determine the effect of ERAS protocol on patient satisfaction, pain catastrophizing and hospital-related anxiety and/or depression following primary total hip arthroplasty. Methods Data were retrospectively reviewed for patients who underwent primary THA between 2017 and 2020. Patients in the control group who received conventional treatment were matched with the ERAS group following the ERAS protocol using a 1:1 ratio by baseline characteristics. All cases in both groups were evaluated and analyzed for pain catastrophizing, depression and anxiety using Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS) at postoperative 1 weeks, 6weeks, 3 months, 6 months and 1 year. Results A total of 182 patients in the ERAS group and 182 patients in the control group were found using propensity score matching. When compared to preoperative outcomes, both groups experienced sizable improvements in all Patient Reported Outcomes (PROs) at the follow-up periods. Compared with the control group, the ERAS group’s satisfaction was significantly higher ( p = 0.002), the pain catastrophizing degree of ERAS group was significantly decreased at 1 week ( p < 0.001), 6 weeks ( p < 0.001) and 3 months ( p = 0.015), and the anxiety degree was significantly decreased at 1 week ( p < 0.001) and 6 weeks ( p < 0.001), respectively. Moreover, depression decreased significantly at 1 week ( p < 0.001), 6 weeks ( p = 0.004), 3 months ( p < 0.001) and 6 months ( p = 0.021), respectively. Patients in the ERAS group experienced faster relief from pain catastrophizing, depression, and anxiety disorders than those in the control group, and maintained a relatively stable mental state at minimum 1-year follow-up. Conclusions Patients undergoing THA following ERAS protocol have a better effect on improving peri-operative patient-reported depression, anxiety, and pain catastrophizing screenings than those following traditional scheme. Therefore, ERAS intervention and management may be beneficial for patients with pain catastrophizing, depression, and anxiety who are planning to undergo THA. Level of evidence III.