APRIL 21, 2025
New research suggests patients with anxiety are more likely to use opioids and have higher pain scores after a total knee arthroplasty (TKA) compared with those without a mental health diagnosis.
“This study provides evidence of the complex relationships between anxiety and in-hospital outcomes in patients undergoing primary TKA,” the authors wrote .
In this retrospective review, the researchers analyzed outcomes for patients diagnosed with anxiety, comparing them with a control
New research suggests patients with anxiety are more likely to use opioids and have higher pain scores after a total knee arthroplasty (TKA) compared with those without a mental health diagnosis.
“This study provides evidence of the complex relationships between anxiety and in-hospital outcomes in patients undergoing primary TKA,” the authors wrote .
In this retrospective review, the researchers analyzed outcomes for patients diagnosed with anxiety, comparing them with a control group of patients without a mental health diagnosis. The team collected self-reported pain scores from each group at rest and with activity immediately after surgery and at discharge. They also gathered data on inpatient opioid usage and discharge disposition.
The study included 4,404 patients, of which 492 were assigned to the anxiety group. Results showed notable differences between the two groups in median pain scores immediately after surgery, when the patient was at rest (anxiety group: 2; IQR, 0-6; control group: 0; IQR, 0-5; P=0.003). Similar differences were found when patients were active (anxiety group: 4; IQR, 0-6; control group: 3; IQR, 0-6; P=0.011), at discharge at rest (anxiety group: 3; IQR, 2-5; control group: 3; IQR, 1-4; P<0.001) and with activity (anxiety group: 5; IQR, 3-6; control group: 4; IQR, 2-6; P<0.001).
In terms of opioid usage, 60% of patients in the anxiety group consumed more than the median of 61 morphine milligram equivalents, compared with 48% of the control group (P<0.001).
The prevalence of elective TKA has increased in recent years, and examining outcomes among patients with mental health concerns can provide data on how an anxiety disorder could influence pain perception and opioid usage.
“Among patients undergoing primary TKA, pain perception, opioid consumption, and discharge to a facility during inpatient recovery may be higher in patients with an anxiety diagnosis,” the authors wrote. “This study provides initial evidence of the complex relationships between mental health and in-hospital outcomes in patients undergoing primary TKA.”
The research is part a larger study examining how mental health affects outcomes after inpatient elective orthopedic surgery.
By Kenny Walter
