The impact of mental health on major complications following total shoulder arthroplasty

Background: The volume of total shoulder arthroplasty (TSA) procedures has seen a remarkable surge over the past decade in the United States. Recent research has shown an association between depression and poorer postoperative outcomes following shoulder, hip, and knee arthroplasties. The purpose of this study was to examine the relationship between patients with a diagnosis of depression and/or anxiety and the risk of major postoperative complications after TSA. Methods: The TriNetX Research Network database was queried on May 30, 2023. Patient cohorts and outcomes were defined using International Classification for Disease, 10^th Edition diagnosis codes and Current Procedural Terminology codes. After propensity score matching, the two cohorts were analyzed for differences in major outcomes within two years following the initial procedure. Results: Of the 45,838 patients who underwent TSA identified in TriNetX, 15,074 patients were included in the depression/anxiety cohort and 30,764 were included in the no depression/anxiety cohort. Propensity score matching was performed to match 13,392 patients from each cohort. Compared to patients with no depression nor anxiety, patients with either depression and/or anxiety were identified to have a higher risk for dislocation (odds ratio [OR] 1.502, 95% confidence interval [CI] 1.285-1.756; P < .001), periprosthetic joint infection (OR 1.309, 95% CI 1.123-1.525; P = .001), periprosthetic fracture (OR 1.661, 95% CI 1.341-2.056; P < .001), and revision TSA (OR 1.316, 95% CI 1.150-1.506; P < .001) within 2 years after the initial procedure. Conclusion: Overall, this study showed that patients who have depression and/or anxiety have a higher risk for dislocation, periprosthetic joint infection, revision TSA, and periprosthetic fracture within two years after TSA.