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

Lunati, Matthew P.; Wilson, Jacob M.; Farley, Kevin X.; Gottschalk, Michael B.; Wagner, Eric R.

doi:10.1016/j.jse.2020.04.015

Cited by 37 publications

(19 citation statements)

References 41 publications

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“…Similar to our prior study on PRCs after THA, patients with alcohol abuse were at high risk of PRCs after TSA, probably because excessive alcohol consumption is associated with weakened immune system and mechanisms, impaired phagocytic function, or induced cytokine abnormalities which may have a relationship with PJI [26,39]. Depression has previously been reported to be associated with a series of adverse outcomes, such as PJI, sepsis, wound complications, return to the operating room for irrigation and debridement, extended LOS, readmission, revision surgery, and greater health care utilization after TSA, in-hospital PRCs after THA and TKA [38][39][40]45]. Although the relationship between depression and in-hospital PRCs after TSA may seem obscure, imbalance of immune system inducing PJI likely explain this.…”

Section: Discussionmentioning

confidence: 99%

“…Although the relationship between depression and in-hospital PRCs after TSA may seem obscure, imbalance of immune system inducing PJI likely explain this. Psychological distress produces a systemic state of in ammation leading to dysregulation of the immune system and a resultant susceptible host state [45]. Additionally, depression itself may in uence T-cell phenotype, and antidepressant medications have been shown to have negative immunoregulatory effects, further causing immune susceptibility [40].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Yang

Xie

Liu

et al. 2021

Preprint

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BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Yang

Xie

Liu

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…This database has been used for various clinical and epidemiological studies, specifically in the field of orthopedics. 14 , 15 …”

Section: Methodsmentioning

confidence: 99%

“…This database has been used for various clinical and epidemiological studies, specifically in the field of orthopedics. 14,15 The database was queried for patients who underwent either ORIF or IMN of an intertrochanteric, peritrochanteric or subtrochanteric femur fracture using the Current Procedural Terminology (CPT) codes 27244 and 27245 (Table 1). Patients were excluded based on several criteria including (1) 6-month noncontinuous preoperative enrollment (ie, patients who were not continuously enrolled in the database for the 6-month period preceding surgery), (2) 12-month noncontinuous postoperative enrollment, (3) open fracture, and (4) those aged less than 65 years.…”

Section: Data Source and Cohort Selectionmentioning

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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“…This specific database has been utilized for various clinical and epidemiological studies, specifically within the field of orthopedics. 13,14 We searched the database for patients who underwent surgical fixation of a pelvic ring and/or acetabular fracture by using the most used Current Procedural Terminology (CPT) codes (Table 1). Exclusion criteria regarding patient selection consisted of six months of non-continuous pre-operative enrollment (ie.…”

Section: Data Source and Cohort Selectionmentioning

confidence: 99%

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

Broggi

Yoon

Allen

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: There is a high post-operative incidence of venous thromboembolisms (VTEs), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), in pelvic ring and acetabular fractures, and identification of risk factors for VTEs is crucial to decrease this highly morbid complication. High altitudes have a known physiological effect on the body that may predispose patients to developing VTEs in the postoperative period. The purpose of this study was to investigate the relationship between pelvic ring and acetabular fractures occurring at high altitudes and the development of postoperative VTEs. Methods: In this retrospective study, the Truven MarketScan claims database was used to identify patients who underwent surgical fixation of a pelvic ring and/or acetabular fracture from January 2009 to December 2018 using Current Procedural Terminology (CPT) codes. Patient characteristics, including medical comorbidities, were collected. The zip codes of where the surgeries took place were used to determine recovery altitude and patients were separated into either the high altitude (>4000 feet) or low altitude (<100 feet) cohorts. Chi-squared and multivariate analyses were performed to investigate the association between altitude and the development of VTE postoperatively. Results: In total, 68,923 patients were included for analysis. At 30-days postoperatively, a higher altitude was associated with increased odds of developing a PE (OR 1.47, p ¼ 0.019). At 90-days postoperatively, a higher altitude was associated with increased odds of DVT (OR 1.24, p ¼ 0.029) and PE (OR 1.63, p < 0.001). Conclusion: Surgical fixation of pelvic ring and acetabular fractures performed at a higher altitude (>4,000feet) are associated with increased odds of developing a PE in the first 30 days as well as developing a DVT or PE at 90 days postoperatively. Future prospective studies are needed to further elucidate the causality of altitude on the development of postoperative VTEs.

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

Cited by 37 publications

References 41 publications

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

Depressive Disorders Lead to Increased Complications After Geriatric Hip Fractures

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

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