Total shoulder - one in seven patients have depression; what difference does that make?

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

These authors sought define the relationship between a preoperative diagnosis of depression and postoperative outcomes in 22,623 patients having total shoulder arthroplasty (TSA).  Of these, 3209 (14%) had a preoperative diagnosis of depression.

Patients with depression have a number of characteristics that are different from those without depression. Specifically, they are more likely to be women, younger patients, obese patients, those who are smoking, as well as those with coronary artery disease, anxiety and rheumatoid arthritis.

Multivariate analysis demonstrated that the following were more common in patients with depression: 

sepsis (odds ratio [OR], 2.04), 

prosthetic joint infection within 1 year (OR, 1.41), 

return to the operating room for irrigation and debridement (OR, 2.72),

prosthetic complication (OR, 1.54), and

wound complication (OR, 1.84). 

Patients with depression also had greater health care utilization including higher odds of 

non-home discharge (OR, 1.43), 

90-day readmission (OR, 1.55), 

90-day emergency department visit (OR, 1.39), and 

extended length of stay (3 days; OR, 1.23).

Comment: This is an important study that points out (1) the commonality of depression among patients having shoulder arthroplasty and (1)  the importance of screening for depression and modifying the preoperative informed consent and the postoperative surveillance for complications. As the authors point out, additional investigation is needed to determine whether this risk factor is modifiable.

The nature of the relationship between adverse our come remains unclear: is it the fact that depression itself increases the risk or is it that adverse outcomes are more likely in women, younger patients, obese patients, those who are smoking, as well as those with coronary artery disease, anxiety and rheumatoid arthritis?

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