Mental and Physical Well-Being Has Continued to Decline Among Patients Undergoing Orthopaedic Surgery from 2019 Through 2024: The Experience of a Single Specialized Academic Center in New York City.
Academic Article
Overview
abstract
BACKGROUND: A strong association exists between outcomes of orthopaedic surgery and patients' preoperative mental health. Therefore, population-wide trends and changes in well-being are of great interest to providers. We sought to describe the well-being among patients undergoing orthopaedic surgery before, during, and after the pandemic. METHODS: Patients who underwent an orthopaedic surgical procedure at 1 specialty hospital in New York City between 2019 and August 2024 were split into prepandemic, pandemic, and postpandemic groups (n = 129,677). Preoperative Patient-Reported Outcome Measurement Information System Scale v1.2-Global Health (PROMIS-GH) mental health (MH) and physical health (PH) scores were analyzed in addition to the proportion of patients with low MH and PH. Demographic and clinical factors associated with low MH/PH were identified. RESULTS: Median PROMIS MH and PH scores declined in the pandemic cohort and remained decreased in the postpandemic cohort. Compared with the prepandemic cohort, the proportion of patients with low MH increased in the pandemic cohort (11% vs. 5%) and increased further in the postpandemic cohort (14%). Compared with the prepandemic cohort, the proportion of patients with low PH increased in the pandemic cohort (37% vs. 25%) and increased further in the postpandemic cohort (40%). Relative to the prepandemic period, the odds of low MH adjusted for demographic, clinical, and social factors were 2.70 for the pandemic period and 3.46 for the postpandemic period; for low PH 1.95 and 2.21, respectively. Factors associated with low MH/PH included preoperative comorbidities, age, sex, ethnicity, insurance type, socioeconomic status, and surgery within the spine service. CONCLUSION: Our results suggest that mental and physical health among patients undergoing orthopaedic surgery in New York City worsened during the pandemic. In the postpandemic period, mental and physical health has continued to decline with a higher proportion of low MH and low PH compared with prepandemic and pandemic levels. The persistent decline observed past the pandemic period indicates that long-term social and societal factors may be associated with population-wide changes in psychosocial functioning rather than exclusively pandemic-specific determinants. In response to this negative trend, surgeons and institutions should consider additional preoperative supports for patients with diminished well-being. LEVEL OF EVIDENCE: Level III-Retrospective cohort study. See Instructions for Authors for a complete description of levels of evidence.
