The Journal of Arthroplasty, Volume 34, Issue 8, 1598 - 1601

Psychological Distress Independently Predicts Prolonged Hospitalization After Primary Total Hip and Knee Arthroplasty

Mohamad J. Halawi, David Chiu, Christian Gronbeck, Lawrence Savoy, Vincent J. Williams, Mark P. Cote
Hip Knee


The purpose of this study was to investigate the effect of psychological distress on hospital length of stay (LOS) in joint arthroplasty (TJA).


A retrospective review of 863 patients who underwent primary, unilateral TJA at a single tertiary academic center was performed. Two groups were compared: patients with or without psychological distress defined using the Short Form-12 mental component summary. The primary outcome was the rate of hospital LOS exceeding 2 days. Secondary outcomes were rates of in-hospital complications and 90-day emergency room visits and readmissions. Univariate and multivariate logistic regression analyses were performed.


The prevalence of psychological distress was 23%. The mean LOS was 2.44 days. Patients with psychological distress were younger ( P < .0001) and more likely to have depression ( P < .0001), lower educational attainment ( P < .0001), smoke tobacco ( P = .003), be Hispanic/Latino ( P = .001), live alone (P = .001), and have higher rates of nonprimary osteoarthritis ( P< .0001). After adjusting for these differences, psychological distress was an independent predictor of LOS > 2 days ( P = .049 and .006 for total hip arthroplasty [THA] and total knee arthroplasty [TKA], respectively). There were no differences in the rates of in-hospital complications ( P = .913 and .782 for THA and TKA, respectively), emergency room visits ( P = .467 and .355 for THA and TKA respectively), or readmissions ( P = .118 and .334 for THA and TKA, respectively).


Psychological distress is an independent predictor of prolonged hospitalization after primary TJA. The Short Form-12 mental component summary is a good screening tool for identifying patients with poor mental health who may not be appropriate candidates for outpatient surgery. Efforts to address psychological distress before surgery are warranted.

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