Preoperative depression is a risk factor for complication and increased health care utilization following total...

The incidence of total shoulder arthroplasty (TSA) continues to increase. Although researchers expect preoperative depression to influence outcomes following primary hip and knee arthroplasty, there is a paucity of data on this relationship after primary TSA. The purpose of this study was to define the relationship between a preoperative diagnosis of depression and postoperative outcomes following TSA.

This was a level III retrospective cohort study. We identified patients undergoing TSA between 2009 and 2017 from the Truven MarketScan database and created 2 cohorts, patients with and without depression. We included patients who were continuously enrolled in the database for 1 year preoperatively and postoperatively. We collected demographic data, complication data, and health care utilization factors and then performed statistical analysis comparing complication and health care utilization between cohorts. This analysis controlled for baseline patient demographic, comorbid, and surgical factors.

We included 22,623 patients undergoing TSA in this study. Of these, 3209 (14%) had a preoperative diagnosis of depression. Multivariate analysis demonstrated that the following were more common in patients with depression: sepsis (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.14-3.65; P = .022), revision within 1 year (OR, 1.92; 95% CI, 1.45-2.55; P < .001), prosthetic joint infection within 1 year (OR, 1.41; 95% CI, 1.04-1.90; P = .025), return to the operating room for irrigation and débridement (OR, 2.72; 95% CI, 1.67-4.42; P < .001), prosthetic complication (OR, 1.54; 95% CI, 1.26-1.88; P < .001), and wound complication (OR, 1.84; 95% CI, 1.2-2.79; P = .004). Similarly, patients with depression had greater health care utilization including higher odds of non-home discharge (OR, 1.43; 95% CI, 1.3-1.57; P < .001), 90-day readmission (OR, 1.55; 95% CI, 1.3-1.86; P < .001), 90-day emergency department visit (OR, 1.39; 95% CI, 1.23-1.57; P < .001), and extended length of stay (≥3 days; OR, 1.23; 95% CI, 1.12-1.36; P < .001).

Depression prior to TSA is common and is associated with increased risk of complications and increased health care utilization following TSA. Determining whether this is a modifiable risk factor requires further investigation.