Risk factors for new-onset anxiety and depression after arthroscopic shoulder stabilization surgery

Shoulder instability is a common shoulder pathology, especially in young athletes involved in contact sports, sometimes requiring surgical intervention. In this retrospective database study, we aimed to identify the incidence of new-onset anxiety or depression (NOAD) after arthroscopic shoulder stabilization surgery, identify risk factors for the development of NOAD, evaluate the effect of NOAD on postoperative complications, and examine whether psychiatric interventions have a protective effect against adverse outcomes.

A retrospective analysis of the PearlDiver national database was completed. Included patients had no prior diagnosis of depression/anxiety or prior utilization of antidepressant medication before shoulder stabilization surgery and had at least 1 year of postoperative follow-up. The primary outcome was the development of NOAD within 1 year postoperatively. Multivariate logistic regression was used to assess predictors of NOAD. Postoperative outcomes were compared between patients who did and did not develop NOAD after propensity score matching. A subgroup comparison of outcomes across various NOAD treatments was performed.

Of the 38,388 patients, 1,950 (5.1%) were diagnosed with NOAD within 1 year postoperatively. Increased age (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.98-0.98; P < .001), increased Charlson Comorbidity Index score (OR: 1.07, 95% CI: 1.01-1.12; P = .012), female sex (OR: 1.72, 95% CI: 1.56-1.89; P < .001), hypermobility (OR: 2.17, 95% CI: 1.33-3.38; P = .001), headaches/migraines (OR: 1.33, 95% CI: 1.20-1.47; P < .001), obesity (OR: 1.49; 95% CI: 1.31-1.70; P < .001), preoperative opioid use (OR: 3.68, 95% CI: 3.34-4.05; P < .001), tobacco use (OR: 2.25, 95% CI: 1.99-2.53; P < .001), and alcohol disorders (OR: 2.13, 95% CI: 1.70-2.64; P < .001) were all associated with a higher risk of developing NOAD. Postoperatively, the NOAD group had a 9.52 times increased risk of 90-day readmission (P < .001), a 1.58-times increased risk of prolonged opioid use (P < .001) at 1 year, increased total cost ($11,107 ± 12,317 vs. $7,695 ± 8,840; P < .001), and a 1.48-times increased risk of revision at 2 years (P < .001). Patients with NOAD undergoing psychotherapy had lower rates of postoperative opioid use.

The postoperative development of NOAD is an understudied but relatively common complication of arthroscopic shoulder stabilization surgery, occurring in approximately 5% of patients. The current study highlights a variety of risk factors that may be used to identify at-risk patient populations. Further work is needed to identify interventions that can mitigate the adverse outcomes associated with NOAD.