Abstract
Objectives:
Recent studies have identified an association between preoperative depression and worse outcomes following arthroscopic rotator cuff repair (RCR) surgery, including lower patient-reported outcomes, increased pain and impairment, and higher rates of complications. Patient Health Questionnaire-2 (PHQ-2) is a commonly administered screening tool for measuring depressive symptoms; however, the relationship between PHQ-2 and postoperative outcomes after RCR is not yet established. The purpose of this study is to investigate the association between depression and reoperation rates in patients undergoing primary RCR.
Methods:
This retrospective chart review evaluated data from all patients who underwent elective primary RCR at 1 health system between March 2016 and December 2021 and had a PHQ-2 score at least 6 months prior to their surgery. The PHQ-2 is a validated tool used to screen for depression with scores ranging from 0-6. Patients were categorized as either depressed (PHQ-2 ≥ 2) or nondepressed (PHQ-2 < 2). Patients <18 years old, history of prior RCR, and patients without PHQ-2 scores within 6 months of surgery were excluded from the study. The primary outcome was to compare reoperation rate, defined as the need for any subsequent surgery related to the primary RCR between depressed and non-depressed patients. The secondary outcome was a comparison of postoperative health care utilization, which included emergency department visits and hospital readmissions within 90 days. Depressed patients were also propensity matched 1:1 to nondepressed patients via age, body mass index (BMI), and tear size for a subanalysis.
Results:
A total of 238 patients who underwent primary RCR were included with 84 depressed patients and 154 nondepressed patients. Significantly more patients were female (67% versus 46%; P = 0.002) in the depressed cohort compared to nondepressed. There was a significantly increased incidence of comorbid depression (63% vs 28%; P < 0.001), anxiety (52% vs 17%; P < 0.001), and substance use disorder (20% vs 6%; P < 0.001) as well as a lower median household income (MHI) in the depressed cohort versus the nondepressed cohort ($58,451.93 ± $21,024.93 vs. $66,751.93 ± $22,654.45; P < 0.001). Fifteen (17.9%) depressed patients underwent reoperation versus 10 (6.5%) nondepressed patients (P = 0.006). Mean time to reoperation in the depressed cohort was 11.7 months (0.8-35 months). In the subanalysis, 80 patients in the depressed cohort and 80 patients in the nondepressed cohort were matched. Depressed patients had significantly higher rates of comorbid depression (63% vs 18%; P < 0.001), anxiety (52% vs 17%; P < 0.001), and substance use disorder (20% vs 6%; P < 0.001) and a lower MHI ($58,615.20 ± $21,455.12 vs $66,470.73 ± $22,996.49; P = 0.04). Fewer patients were employed full time (22% vs. 44%) and more were disabled (30% vs 8%) amongst the depressed cohort (P = 0.003). Amongst depressed patients, 14 patients (17.5%) versus 4 (5%) underwent reoperation (P = 0.01). No significant differences in postoperative emergency department visits, postoperative complications, or hospital readmissions were found between the depressed and nondepressed cohorts in either analysis.
Conclusions:
We found patients screening positive for depression preoperatively, as measured by PHQ-2, had a significantly higher reoperation rate following primary RCR compared to nondepressed patients. These patients were more likely to be female, have comorbid mental health diagnoses, no full-time employment, and a lower household income. Screening for depression preoperatively could be a useful adjunct for providers to better identify patients at risk for worse outcomes.
