1353 - The Role of Perioperative Ketamine in Shaping Psychiatric and Functional Outcomes After Total Hip Arthroplasty

Objectives: To evaluate whether intraoperative ketamine administration influences short-term psychiatric outcomes after THA in patients with preexisting Major Depressive Disorder (MDD) and/or Generalized Anxiety Disorder (GAD), with implications for postoperative rehabilitation and functional recovery.

Design: We conducted a retrospective cohort study using TriNetX’s Global Collaborative Network across 152 healthcare organizations. Adults (≥18 years) undergoing THA with a diagnosis of MDD, GAD, or depressive episode were included. Two cohorts were created using 1:1 propensity score matching for demographics and comorbidities: patients who received intraoperative ketamine (n=21,394) and those who did not (n=21,394). Outcomes were measured over 90 days postoperatively, including depressive episodes, anxiety episodes, and psychiatric medication use.

Results: Compared to controls, the ketamine group demonstrated a higher risk of depressive episodes (24.9% vs. 20.2%; RR 1.24; OR 1.31; HR 1.28; p< 0.0001), anxiety disorders (22.7% vs. 17.6%; RR 1.29; OR 1.37; HR 1.34; p< 0.0001), and psychiatric medication use (38.6% vs. 35.8%; RR 1.08; OR 1.13; HR 1.09; p< 0.0001). These findings suggest that intraoperative ketamine may not confer psychiatric protection in this high-risk population and may in fact exacerbate symptoms that are known to hinder engagement in physical therapy, delay mobilization, and prolong recovery trajectories after THA.

Conclusions: Intraoperative ketamine use in THA patients with preexisting depression and anxiety was associated with increased risk of postoperative depressive episodes, anxiety disorders, and psychiatric medication use. Rather than offering psychiatric protection, ketamine may compound mental health challenges that interfere with rehabilitation, slow mobilization, and limit functional recovery. These findings highlight the need for physiatry-led approaches that integrate psychiatric management into perioperative care pathways. Future work should explore strategies that support both mental health and rehabilitation outcomes to optimize post-THA recovery.