Poster 24: The Impact of Mental Illness on Outcomes Following Shoulder Arthroscopy

Abstract

Objectives:

There has been a recent push to identify links between mental health and outcomes following orthopaedic procedures. There have been few investigations into the impact of mental health on outcomes following shoulder arthroscopy. While there is limited evidence that demonstrates that patients with poor mental health experience worse outcomes following arthroscopic procedures, these studies do not usually control confounding variables such as Body Mass Index (BMI) and comorbidities such as cardiovascular disease, diabetes, and hypertension. The objective of this study was to control for confounding variables to better determine if the presence of a mental health condition in isolation worsens operative outcomes in shoulder arthroscopy.

Methods:

A retrospective chart review was performed of patients who underwent shoulder arthroscopy between 2007 and 2022 at a single institution. The mental health conditions assessed were associated with depression, anxiety, trauma, and bipolar disorder, and schizoid disorders. Multivariable regression modeling was used to control for covariates and determine the odds ratios of adverse clinical outcomes for patients with mental health conditions. The following patient-reported outcome measures were collected: PROMIS10SF-GH, ASES, and QuickDASH.

Results:

A total of 3,368 patients who underwent shoulder arthroscopy were identified in this study. Of these patients, 861 (25.6%) had a documented diagnosis of a mental health condition prior to surgery, while 2,507 (74.4%) did not. Of the patients with a preexisting mental health condition, 683 (79.3%) were diagnosed with anxiety disorders, 410 (47.6%) with depression, 271 (31.5%) with substance-related disorders, 208 (24.2%) with trauma/stress-related disorders, 54 (6.3%) with alcohol-related disorders, 30 (3.5%) with bipolar disorder, and 12 (1.4%) with schizophrenia.

The combined outcomes for patients who underwent shoulder arthroscopy demonstrate a 90-day readmission rate of 0.7% for patients without a preexisting mental health condition and 2.6% for patients with a preexisting diagnosis. The 90-day reoperation rate was 0.3% for patients without a previous diagnosis and 0.1% for those with a previous diagnosis. The 1-year mortality rates were 0.2% and 0.1% for patients without and with a preexisting mental health condition, respectively.

The results of the multivariable regression models can be found in Figure 1. For readmission within 90 days, there were significant associations between the presence of any mental health condition (odds ratio (OR) = 2.407, P = .0124), diagnosis of depression alone (OR = 2.346, P = .0239), and diagnosis of anxiety alone (OR = 2.113, P = .0333) and the odds of readmission within 90 days. For reoperation within 90 days, there were not significant associations between the diagnosis of any mental health condition (OR = .327, P = .2968), diagnosis of depression alone (OR = .774, P = .8117), or diagnosis of anxiety alone (OR = .454, P = .4614) and the odds of reoperation within 90 days. For mortality within 1 year, there were not significant associations between the diagnosis of any mental health condition (OR = .728, P = .7762), diagnosis of depression (OR = 1.806, P = .5975), or diagnosis of anxiety (OR = .983, P = .9876) and the odds of mortality at 1 year.

On the PROMIS10SF-GH, patients with any mental health condition, those with depression alone, and those with anxiety alone demonstrated significantly decreased scores than patients without a mental health condition (Figure 1A, B). On the ASES questionnaire, preoperatively, patients diagnosed with depression alone demonstrated significantly lower scores than patients without a mental health condition (Figure 1C). At 6 months postoperatively and at the MRF, patients diagnosed with any mental health condition, depression alone, or anxiety alone demonstrated significantly lower ASES scores. For the QuickDASH questionnaire, preoperatively, patients diagnosed with depression alone demonstrated significantly higher QuickDASH scores than patients without a mental health condition (Figure 1D). At 6 months postoperatively, QuickDASH scores for patients with a diagnosis of any mental health condition, depression alone, and anxiety alone were significantly higher than those of patients without a mental health condition. At the MRF, QuickDASH scores for patients diagnosed with any mental health condition and depression alone were significantly higher than those of patients without a mental health condition.

Conclusions:

A preexisting mental health condition increases the odds of readmission and leads to worse patient-reported outcomes following shoulder arthroscopy. Orthopaedic surgeons should be aware that their patients’ mental health statuses may affect their postoperative courses following shoulder arthroscopy.