Association of mental health disorders with postoperative complications following total shoulder arthroplasty

Background: Mood disorders are highly prevalent among orthopedic patients and have been shown to be associated with adverse outcomes after orthopedic surgeries. There has been conflicting evidence regarding the relationship of mental illness with outcomes following total shoulder arthroplasty (TSA). The purpose of this study was to examine the relationship between mental health disorders and postoperative TSA outcomes in patients with anxiety, depression, bipolar disorder, and schizophrenia. Methods: Patients with osteoarthritis undergoing a primary TSA over 2010-2021 were identified in the PearlDiver claims database. Patients with anxiety, depression, bipolar disorder, or schizophrenia, identified using the International Classification of Diseases-9 and -10 codes, were compared to a control cohort composed of patients without any of these diagnoses. Two-year surgical outcomes and 90-day medical complications were analyzed via multivariable logistic regression, controlling for age, sex, and Charlson comorbidity index. Results: A total of 96,039 TSA patients were identified. Four thousand eight hundred thirty-nine had an anxiety disorder, 18,936 had depression, 2100 had bipolar disorder, and 437 had schizophrenia. Average cohort age ranged between 61 and 69 years. Patients with anxiety disorders (odds ratio [OR] = 1.12), depression (OR = 1.41), bipolar disorder (OR = 1.85), and schizophrenia (OR = 1.31) were all more likely to experience an emergency department visit within 90 days when compared to the control (P < .05 for all). All groups were also more likely to have various 90-day medical complications (P < .05). Patients with depression (OR = 1.33) and bipolar disorder (OR = 1.44) were significantly more likely to undergo all-cause revision within two years postoperatively (P < .05 for all). Conclusion: Mental illness is associated with worse 90-day postoperative complications after TSA, particularly emergency department visits. These complications not only increase morbidity but also resource utilization and cost of care. As TSA is an elective procedure, shoulder arthroplasty surgeons should ensure patients’ mental health is optimized with the care they need to minimize the risk of adverse postoperative complications.