Is the use of antidepressants associated with patient-reported outcomes following total hip replacement surgery?

Background and purpose — Patients with anxiety and/or depres- sion tend to report less pain reduction and less satisfaction with surgical treatment. We hypothesized that the use of antidepres- sants would be correlated to patient-reported outcomes (PROs) 1 year after total hip replacement (THR), where increased dosage or discontinuation would be associated with worse outcomes. Patients and methods — THR cases with pre- and postopera- tive patient-reported outcome measures (PROMs) were selected from the Swedish Hip Arthroplasty Register (n = 9,092; women: n = 5,106). The PROMs were EQ-5D, visual analog scale (VAS) for pain, Charnley class, and VAS for satisfaction after surgery. These cases were merged with a national database of prescrip- tion purchases to determine the prevalence of antidepressant purchases. Regression analyses were performed where PROs were dependent variables and sex, age, Charnley class, preop- erative pain, preoperative health-related quality of life (HRQoL), patient-reported anxiety/depression, and antidepressant use were independent variables. Results — Antidepressants were used by 10% of the cases (n = 943). Patients using antidepressants had poorer HRQoL and higher levels of pain before and after surgery and they experi- enced less satisfaction. Preoperative antidepressant use was inde- pendently associated with PROs 1 year after THR regardless of patient-reported anxiety/depression. Interpretation — Antidepressant usage before surgery was associated with reduced PROs after THR. Cases at risk of poorer outcomes may be identifi ed through review of the patient’s medi- cal record. Clinicians are encouraged to screen for antidepres- sant use preoperatively, because their use may be associated with PROs after THR.