Depressive disorder linked with added complications, longer in-hospital stay after RSA
Click Here to Manage Email Alerts
CHICAGO — Patients with depressive disorder developed serious complications and experienced a higher frequency of adverse events after reverse shoulder arthroplasty for glenohumeral osteoarthritis, results of a retrospective study showed.
In research presented at the American Academy of Orthopaedic Surgeons Annual Meeting, here, Keith Diamond, MD, and colleagues noted patients with depressive disorder (DD) also had higher health care costs following RSA surgery than patients without this disorder, incurring significantly higher episode of care costs of $19,363 vs. $17,927 for patients matched to them by age, sex and comorbid conditions.
“Depressive disorders can negatively impact patients undergoing primary RSA for the treatment of glenohumeral osteoarthritis. Patients should know they are at risk for increased length of stay, medical complications and 90-day episode of care costs,” Diamond told Healio.
Payer database used
With RSA performed for glenohumeral OA becoming more common, researchers sought to determine whether patients with DD who undergo this surgery experience higher rates of in-hospital length of stay; medical complications, such as cerebrovascular (CV) events, pneumonia, myocardial infarction, venous thromboembolism (VTE) and other complications; and have higher episode of care costs.
Querying a private-payer database retrospectively from January of 2010 to December of 2019, Diamond and colleagues included in the study 28,410 patients with DD who underwent primary RSA for glenohumeral OA. For the analysis, they matched these patients 1:5 (4,084) to a similar comparison group without DD who had the same surgery (24,362), to minimize possible confounding. Researchers used various tests and models to calculate and analyze variables of interest.
Study endpoints were to determine whether DD was associated with longer in-hospital length of stay, higher rates of complications and higher total global 90-day episode of health care costs.
Hospital stay longer in DD group
Results showed a significantly longer in-hospital stay of 3 days for patients with DD compared with 2 days for the control group. During the episode of care, patients with DD had a higher frequency and odds of developing certain adverse events vs. the control group.
Diamond told Healio, “While we all think of depression as a psychiatric illness, our data indicate that there are high rates of pneumonia, CV accidents (strokes), myocardial infarctions (heart attacks), acute kidney injury, surgical site infections and more. The effect of depression upon our patients extends beyond mental health and affects the respiratory, cardiac, vascular and renal systems.”
When orthopedic surgeons are aware of these possible complications, they can help patients avoid some of these complications, like VTE, by encouraging patients to get out of bed, be physically active and be focused on their daily self-care preoperatively and postoperatively, according to Diamond.
“At Maimonides Medical Center, we have begun screening patients for psychiatric disorders prior to undergoing shoulder surgery. We make sure to educate our patients that their mental health can affect their musculoskeletal health during their shoulder surgery and afterward,” he said.
Collapse
Diamond K, et al. Paper 426. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 22-26, 2022; Chicago.
Read more about
Click Here to Manage Email Alerts