Impact of Enhanced Recovery After Surgery on Psychological Outcomes in Total Hip Arthroplasty.

Background: The occurrence of pain catastrophizing, depression, and anxiety is prevalent among patients undergoing primary total hip arthroplasty (THA). The Enhanced Recovery After Surgery protocol (ERAS-P) has demonstrated its efficacy in alleviating peri-operative stress responses in such patients. This study endeavors to explore the influence of ERAS-P on patient satisfaction, as well as the levels of pain catastrophizing, surgery-related anxiety, and depression following primary THA.

Hypothesis: ERAS-P exerts a beneficial influence on patient satisfaction, mitigating pain catastrophizing, and reducing surgery-related anxiety and depression following primary THA.

Patients And Methods: Data were retrospectively reviewed for patients who underwent primary THA between 2017 and 2020. Patients in the control group who received usual care were matched in a 1:1 ratio for baseline characteristics to patients in the ERAS-P group who followed ERAS-P. All patients were evaluated and analyzed for pain catastrophizing, depression and anxiety using the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS) at postoperative 1 weeks, 6 weeks, 3 months, 6 months and 1 year.

Results: 182 patients in the ERAS-P group and 182 in the control group were analyzed using propensity score matching (PSM). Compared to the control group, ERAS-P patients showed significantly higher satisfaction levels (p = 0.002). They also experienced a notable reduction in pain catastrophizing at 1 week, 6 weeks, and 3 months postoperatively (p < 0.05 for all). Anxiety levels decreased markedly at 1 week and 6 weeks (p < 0.001 for both). Depression scores in the ERAS-P group declined significantly at these same time points up to 6 months (p < 0.05 for all). Remarkably, ERAS-P patients exhibited a greater decrease in peri-operative pain catastrophizing and anxiety, accompanied by a faster recovery. However, its effectiveness waned over time, with both groups reporting comparable outcomes within a few months.

Discussion: Patients undergoing THA after adhering to the ERAS-P exhibit a more favorable outcome in improving peri-operative patient-reported depression, anxiety, and pain catastrophizing screenings compared to those following the traditional care scheme. Although these advantages gradually diminished over time, the outcomes for both groups converged to be similar within a few months. Nonetheless, ERAS-P retains its notable advantages for THA patients who grapple with psychological symptoms.

Level Of Evidence: III.