A Nationwide Analysis Demonstrates Anxiety Disorders are Associated with Higher Rates of Pneumonia, Pulmonary Embolism, Deep Vein Thrombosis and Acute Renal Failure Following Hip Arthroscopy for Femoral Acetabular Impingement Syndrome: A Matched-Control Analysis.

Abstract

Purpose: To utilize a nationwide administrative database (PearlDiver) to investigate if patients with general anxiety disorder (GAD) undergoing primary hip arthroscopy for femoral acetabular impingement syndrome (FAIS) have higher rates of: 1) medical complications; 2) readmission rates; and 3) costs of care, as compared to patients without GAD.

Methods: Using the PearlDiver database, a retrospective query from January 1^st, 2010 to March 31^st, 2020 was performed to include all patients who underwent hip arthroscopy for FAIS. From this base population, patients with a diagnosis of GAD were identified and represented as the study group. The study group was matched at a 1:5 ratio to a control group of patients without GAD who underwent hip arthroscopy for FAIS by age, sex, and multiple comorbidities (depression, hypertension, diabetes mellitus, and tobacco use). Primary outcomes analyzed included: 90-day medical complications, 90-day readmission rates, and 90-day costs of care. Chi-square analyses were used to compare patient demographics. Logistics regression analyses were used to calculate odds-ratios (OR) of medical complications and readmissions. Welch's t-test were used to compare costs. Bonferroni-correction was performed to reduce the probability of a type I error. This was done by taking the standard p-value of 0.05 and dividing it by the total number of dependent variables analyzed in the study. As such, a p-value less than 0.005 was considered statistically significant.

Results: The query yielded 7,631 patients with GAD undergoing hip arthroscopy for FAIS. These patients were compared to 38,145 matched controls without GAD. Patients with anxiety were at significantly higher risk for post-surgical complications, with the highest risks observed for pneumonia (1.0% vs 0.4%; OR 2.57, 95% CI: 1.97 - 3.35, p = 0.004) and deep vein thrombosis (DVT) (0.36% vs 0.15%; OR 2.42, 95% CI: 1.52 - 3.76, p = 0.002). Other significant risks included acute renal failure (0.46% vs 0.21%; OR 2.13 95%CI: 1.42 - 3.15, p = 0.002) and pulmonary embolism (0.21% vs 0.13%; OR 1.66, 95%CI: 0.92 - 2.87, p = 0.001). There was no statistical difference in readmission within 90-days (1.46% vs 1.24%; OR 2.38, 95% CI: 2.13 - 2.67, p = 0.02) or 90 day total cost of care between the two groups ($4,812 +/- 1,292 vs $ 4,076 +/- 1,179, p = 0.73).

Conclusion: After adjusting for age, sex, and medical comorbidities; this study found GAD was associated with a significantly higher rate of pneumonia, DVT, acute renal failure, and PE following hip arthroscopy for FAIS. There were no significant differences in 90-day readmissions rates or 90-day total cost of care. Considering the relatively high prevalence of anxiety and the increasing rate of hip arthroscopy, preoperative screening for anxiety may help surgeons identify and protect patients at increased risk of complications after hip arthroscopy LEVEL OF EVIDENCE: III; retrospective comparative case-control study.