Prevalence of Psychiatric Diagnoses and Preoperative Opioid Use Among Patients Undergoing Hip Arthroscopy: A Systematic Review and Meta-analysis

Abstract

Background:

Psychiatric morbidity (anxiety, depression, prior opioid use) is variably reported among patients undergoing hip arthroscopy, with prevalence estimates influenced by heterogeneous case definitions and ascertainment methods. Clarifying true prevalence and method-related differences is needed to inform preoperative screening and comparative research.

Purpose:

To quantify the pooled prevalence of psychiatric diagnoses and prior preoperative opioid use among adults undergoing hip arthroscopy and to evaluate how prevalence varies by ascertainment method.

Study Design:

Systematic review and meta-analysis; Level of evidence, 3.

Methods:

The authors performed a PRISMA-compliant search of PubMed, Embase, PsycINFO, and Web of Science from inception to June 19, 2025. Observational studies reporting extractable prevalence of any psychiatric diagnosis, anxiety, depression, or prior opioid use among adult hip arthroscopy cohorts were eligible. Two reviewers independently screened articles, extracted data, and assessed risk of bias (Joanna Briggs Institute checklist). Pooled prevalences were estimated using random effects meta-analysis on logit-transformed proportions with continuity corrections; heterogeneity was summarized with τ² and I². Prespecified subgroup and meta-regression examined the ascertainment method as a moderator.

Results:

Thirty-eight studies met inclusion criteria (any psychiatric diagnosis, k = 27; anxiety, k = 12; depression, k = 17; prior opioid use, k = 14). Pooled prevalences were as follows: any psychiatric diagnosis, 24.6% (95% CI, 17.3%-33.8%; I² = 99.3%); anxiety, 16.6% (95% CI, 13.1%-20.7%; I² = 98.8%); depression, 12.9% (95% CI, 7.5%-21.3%; I² = 99.6%); and prior opioid use, 14.8% (95% CI, 5.7%-33.4%; I² = 99.9%). Validated screening instruments yielded higher prevalences as compared with International Classification of Diseases/administrative codes. Meta-regression attributed a portion of between-study variability to ascertainment (R² analog; 13.6% for any psychiatric diagnosis, 33.1% for anxiety).

Conclusion:

Psychiatric conditions and prior opioid use are common among adults presenting for hip arthroscopy, but measured prevalence depends strongly on the ascertainment method. Code-based approaches are likely to underascertain cases relative to validated screeners. The routine use of brief, validated screeners and standardized reporting would improve identification, facilitate referrals, and yield more comparable prevalence estimates across studies.