Preoperative Depression Is Associated With Increased Risk Following Revision Total Joint Arthroplasty

Wilson, Jacob M.; Farley, Kevin X.; Erens, Greg A.; Bradbury, Thomas L.; Guild, George N.

doi:10.1016/j.arth.2019.11.025

Cited by 45 publications

(37 citation statements)

References 41 publications

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“…Despite this, our cohort of patients with depression was more likely to consist of young, obese, female patientsdsimilarly to prior work. 4,8,28,30,42 These findings confirm prior literature and expand on previously reported results in shoulder arthroplasty. 4,28 Prior studies examining the effect of psychological illness and outcomes following TSA are limited in their methodology.…”

Section: Discussionsupporting

confidence: 90%

“…In support of this notion, the incidence of depression found in this cohort is similar to that reported in an all-insured revision lower-extremity arthroplasty population. 42 Still, given our reliance on clinically documented depression, we likely underestimate the true prevalence within this patient population. Despite this, our cohort of patients with depression was more likely to consist of young, obese, female patientsdsimilarly to prior work.…”

Section: Discussionmentioning

confidence: 98%

“…41 Follow-up patient evaluations have repeatedly demonstrated a relationship between infection and depression following arthroplasty procedures. 25,28,42 Although this relationship may seem obscure, psychological distress produces a systemic state of inflammation leading to preoccupation of the immune system and a resultant susceptible host state. 19 Other work has demonstrated that depression may influence T-cell phenotype, further propagating immune susceptibility.…”

Section: Discussionmentioning

confidence: 99%

“…We have also observed these findings following lower-extremity arthroplasty, as have investigators in other surgical fields. 5,6,10,12,21,42 Despite these findings, one must understand that the relationship between depression and outcomes following arthroplasty is likely complex. It is well established that chronic pain is a risk factor for psychological manifestations in the form of depression and anxiety.…”

Section: Discussionmentioning

confidence: 99%

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

Lunati

Wilson

Farley

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: 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. Methods: 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. Results: 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

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Lunati

Wilson

Farley

et al. 2021

Journal of Shoulder and Elbow Surgery

Self Cite

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“…In the adult reconstruction and foot and ankle literature, preoperative depression in patients undergoing total hip and knee arthroplasty, revision hip and knee arthroplasty, and total ankle arthroplasty has been found to be associated with increased risk of complication and increased healthcare resource utilization. 9 …”

Section: Introductionmentioning

confidence: 99%

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Broggi

Oladeji

Tahmid

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Intertrochanteric hip fractures are a common injury treated by orthopedic surgeons and the incidence rate is rising. Preoperative depression is a known risk factor for postoperative complications in orthopaedic surgery, however its effects on outcomes after geriatric hip fractures is relatively unknown. The purpose of this study was to investigate the relationship between preoperative depression and potential complications following open reduction internal fixation (ORIF) and intramedullary nailing (IMN) of geriatric hip fractures. Methods: In this retrospective study, the Truven Marketscan claims database was used to identify patients over age 65 who underwent ORIF or IMN for a hip fracture from January 2009 to December 2019. Patient characteristics, such as medical comorbidities, were collected and from that 2 cohorts were established (one with and one without depression). Chi-squared and multivariate analysis was performed to investigate the association between preoperative depression and common postoperative complications following intertrochanteric hip fracture surgery. Results: In total, 78,435 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds after undergoing ORIF were surgical site infections (OR 1.32; CI 1.23-1.44), ED visit for pain (OR 1.27; CI 1.16-1.39), wound complications (OR 1.26; CI 1.14-1.35), and non-union (OR 1.25; CI 1.17-1.33). In the patients with preoperative depression undergoing IMN, the complications associated with the greatest increased odds after were surgical site infections (OR 1.37; CI 1.31- 1.45), ED visit for pain (OR 1.31; CI 1.19-1.44), wound complications (OR 1.23; CI 1.10-1.39), and pneumonia (OR 1.22; CI 1.10-1.31). Conclusions: Preoperative depression in patients undergoing hip fracture surgery is associated with increased complications. Recognizing a patients’ preoperative depression diagnosis can allow physicians to adapt perioperative and postoperative surveillance protocols for these higher risk patients. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor

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Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection

et al. 2022

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Background Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience psychological distress and symptoms of depression, both of which are linked to poor postoperative outcomes. We, therefore, aim to identify the prevalence of depression and depressive symptoms in patients before treatment for PJI and their link to functional outcomes. Methods Patients undergoing either debridement with implant retention (DAIR) or 2-stage exchange for PJI with minimum 1-year follow-up were retrospectively reviewed. The 2-stage (n = 37) and single-stage (n = 39) patients that met inclusion criteria were matched based off age (±5 years), gender, and body mass index (±5) to patients undergoing aseptic revisions. Outcomes evaluated included a preoperative diagnosis of clinical depression and preoperative and postoperative Veterans RAND 12 Item Health Survey mental component score and physical component score. Results Compared to matched controls, the prevalence of depressive symptoms was significantly greater in patients undergoing 2-stage exchange preoperatively (40.5% vs 10.8%, P < .01) but not postoperatively (21.6% vs 10.8%, P = .20). Patients undergoing DAIR with either preoperative depressive symptoms (31.3 vs 40.9, P = .05) or a preoperative diagnosis of depression (27.7 vs 43.1, P < .01) had significantly lower physical component scores postoperatively. Conclusions Patients undergoing 2-stage exchange for PJI have a four times higher prevalence of preoperative depressive symptoms than patients undergoing aseptic revision. Patients undergoing DAIR with depression or preoperative depressive symptoms have lower functional scores postoperatively. Orthopedic surgeon screening of PJI patients with referral for treatment of depression may help improve outcomes postoperatively.

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Preoperative Depression Is Associated With Increased Risk Following Revision Total Joint Arthroplasty

Cited by 45 publications

References 41 publications

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

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

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection

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