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Shows the severity of postoperative depression among adult orthopedics surgical patients in Amhara Regional CSHs, North-West Ethiopia.
Source publication
Background
Postoperative depression is one of the devastating problems and important health concerns in adult orthopedics surgical patients. It is often under-diagnosed and appropriate perioperative management of patients is recommended. This study aimed to determine the magnitude and factors associated with postoperative depression among orthopedi...
Citations
Background
It is unknown if nonpharmacologic interventions are protective of adverse outcomes in depression patients. We studied whether depression screenings/psychotherapy visits were associated with lower: (a) medical complications, (b) readmission rates, (c) implant-related complications, and (d) healthcare expenditures.
Methods
A nationwide claims database was queried for primary shoulder arthroplasty from 2010 to 2020. Depression patients included those who had (n = 3566) and did not have (n = 17,769) a pre-operative depression screen/psychotherapy visit within 3 months of shoulder arthroplasty. A 90-day period was utilized for complications and readmissions. Implant complications were assessed over 2 years. Costs were surgeon reimbursements. Logistic regression models computed odds ratios (OR) of complications and readmissions. P-values less than 0.005 were significant.
Results
Depression patients who did not undergo screening had threefold higher odds of 90-day medical complications (28.08 vs. 7.26%; OR: 3.33, p < 0.0001). Readmissions (3.97 vs. 3.48%; p = 0.719) were similar between non-screened vs. screened patients. Implant complications were higher among non-screened vs. screened patients (15.89 vs. 8.02%; OR: 1.93, p < 0.0001), including prosthetic joint infections (2.05 vs. 0.93%; OR: 2.04, p < 0.0001). Costs were significantly higher in patients without screening ($10,916 vs $8703; p < 0.0001).
Discussion
Shoulder arthroplasty surgeons may consider counseling their depression patients about the importance of having a recent screening by their physician.
Objectives:
Studies have reported the detrimental effects of depression following spine surgery, however none have evaluated whether preoperative depression screening, in patients with a history of depression, is protective from adverse outcomes and lowers healthcare costs. We studied whether depression screenings/psychotherapy visits within 3 months prior to 1-2 level lumbar fusion (1-2LF) were associated with lower: 1) medical complications; 2) emergency department (ED) utilizations; 3) readmissions; and 4) healthcare costs.
Methods:
The PearlDiver database from 2010 to 2020 was queried for depressive disorder (DD) patients undergoing primary 1-2LF. Two cohorts were 1:5 ratio matched and included those with (n=2,622) or without (n=13,058) a pre-operative depression screen/psychotherapy visit within 3 months of LF. A 90-day surveillance period was utilized to compare outcomes. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.003 were significant.
Results:
DD patients without depression screening had significantly greater incidence and odds of experiencing medical complications (40.57% vs. 16.00%; OR: 2.71,p<0.0001). Rates of ED utilization were increased in patients without screening vs. screening (15.78% vs 4.23%; OR: 4.25,p<0.0001), despite no difference in readmissions (9.31% vs 9.53%; OR: 0.97,p=0.721). Finally, 90-day reimbursements ($51,160 vs $54,731) were significantly lower in the screened cohort (all p<0.0001).
Conclusions:
Patients who underwent a pre-operative depression screening within 3 months of lumbar fusion had decreased medical complications, ED utilizations, and lower healthcare costs. Spine surgeons may use this data to counsel their patients with depression prior to surgical intervention.
