Mental Health Disorders – Shoulder Replacement

Impact of Mental Health Disorders on Outcomes Following Shoulder Arthroplasty

Liu, Gaetano, Chen, Shivdasani, MacConnell, Garbis, Salazar

https://doi.org/10.1016/j.jse.2024.11.008.

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Background:

There is conflicting evidence on the impact of mental health on postoperative 3 outcomes following total joint arthroplasty. Specific to shoulder arthroplasty there is a lack of 4 data investigating the correlation between mental health and surgical outcomes. Most studies 5 have focused on patient-reported outcome measures, while few have explored objective clinical 6 outcomes. Additionally, studies that do explore clinical outcomes often fail to control for 7 comorbidities. The purpose of this study is to determine if the presence of a mental health 8 condition is associated with poorer outcomes after shoulder arthroplasty when accounting for 9 covariates

Methods:

A retrospective chart review was performed on patients who underwent primary 11 shoulder arthroplasty between 2007 and 2022 at a single institution. Mental health diagnoses 12 assessed included disorders associated with depression, anxiety, trauma, alcohol-use disorder, 13 bipolar disorder, and schizoid disorders. Multivariable regression modeling was used to control 14 for confounding variables and assess the likelihood of adverse clinical outcomes for patients with 15 mental health disorders. Patient-reported outcome measures were also collected and compared

Results:

1169 patients underwent shoulder arthroplasty between January 2007 and September 17 2023 at our institution. After controlling for covariates, all-cause readmission within 90 days was 18 found to be significantly associated with alcohol-related disorders (OR = 3.22 [95% CI, 1.30- 19 7.23], p = .007) and bipolar disorders (OR = 4.21 [95% CI, .88-15.58], p = .043). 

Conclusion:

After adjusting for covariates, alcohol-related and bipolar disorders may be 21 associated with increased risk of 90-day readmission after shoulder arthroplasty, but further 22 investigation is necessary in order to better assess these effects. No associations were found between any mental health disorders and 90-day reoperation of the same joint, 365-day 24 mortality, or patient-reported outcomes

My Opinion:

While there is a social taboo regarding matters of mental and psychological health / disorder, this is as important as any other aspect of healthcare. While interacting with patients, assessing mental state is important when formulating a diagnosis and treatment plan. Some treatments are not appropriate if a patient cannot participate in the pre- and post-operative care. Having a shoulder replacement when the patient cannot participate in post-operative rehabilitation, can lead to a worse situation for the patient than not having a surgery. Hence mental health assessment and care are considered seriously when formulating a treatment plan, and especially for a shoulder replacement.