Depression screening within 3 months of primary shoulder arthroplasty decreases medical complications, implant complications, and costs of care in patients with diagnosed depressive disorder

Abstract

Background It is unknown if nonpharmacologic interventions are protective of adverse outcomes in depression patients. We studied whether depression screenings/psychotherapy visits were associated with lower: (a) medical complications, (b) readmission rates, (c) implant-related complications, and (d) healthcare expenditures. Methods A nationwide claims database was queried for primary shoulder arthroplasty from 2010 to 2020. Depression patients included those who had (n = 3566) and did not have (n = 17,769) a pre-operative depression screen/psychotherapy visit within 3 months of shoulder arthroplasty. A 90-day period was utilized for complications and readmissions. Implant complications were assessed over 2 years. Costs were surgeon reimbursements. Logistic regression models computed odds ratios (OR) of complications and readmissions. P-values less than 0.005 were significant. Results Depression patients who did not undergo screening had threefold higher odds of 90-day medical complications (28.08 vs. 7.26%; OR: 3.33, p < 0.0001). Readmissions (3.97 vs. 3.48%; p = 0.719) were similar between non-screened vs. screened patients. Implant complications were higher among non-screened vs. screened patients (15.89 vs. 8.02%; OR: 1.93, p < 0.0001), including prosthetic joint infections (2.05 vs. 0.93%; OR: 2.04, p < 0.0001). Costs were significantly higher in patients without screening ($10,916 vs $8703; p < 0.0001). Discussion Shoulder arthroplasty surgeons may consider counseling their depression patients about the importance of having a recent screening by their physician. Level of Evidence: III