Preoperative Acute Depressive Episodes Are Associated With Increased Medication Prescribing and Inpatient Services After Primary Arthroscopic Rotator Cuff Repair.

Abstract

To compare postoperative health care use, prescriptions, and shoulder surgery between patients with an acute depressive episode (ADE) and those without an acute depressive episode (NADE) within 3 months before arthroscopic rotator cuff repair. Diagnostic and procedural codes were used to identify patients in the TriNetX Research Network at least 18 years of age and underwent arthroscopic rotator cuff repair between January 2010 and November 2021. Patients with a previous rotator cuff repair or diagnosis of recurrent major depressive disorder were excluded. Patients were stratified into ADE and NADE cohorts and propensity matched. Outcomes were measured by health care use and medication prescribing up to 3 months and incidence of future shoulder surgery up to 2 years postoperatively. After propensity matching, the ADE cohort included 1,514 patients and were compared with 1,514 patients in the NADE cohort. Preoperative characteristics were similar including female sex (62.1% and 63.0%, respectively, P = .599). A greater percentage of the ADE cohort received inpatient services within 3 months (4.5% vs 3.0%, odds ratio [OR] 1.54; confidence interval [CI] 1.05-2.25, P = .027) after surgery. Patients with ADE were prescribed a greater percentage of antidepressants (32.8% vs 24.4%, OR 1.51, 95% CI 1.29-1.77, P < .0001), sedatives (25.2% vs 20.5%, OR 1.31, CI 1.11-1.55, P = .002), and opioid analgesics (63.4% vs 55.7%, OR 1.38 CI 1.19-1.59, P < .0001) within 3 months. Within 2 years, incidence of future surgery were similar for arthroscopy (7.9% vs 7.3%) and arthroplasty (2.2% vs 1.6%). Acute depressive episodes before primary arthroscopic rotator cuff repair are associated with increased use of inpatient services and postoperative analgesic prescriptions. Incidence of future shoulder surgery for arthroscopy and arthroplasty was similar between patients with or without ADEs. Level III, retrospective cohort study.