Impact of Mental Health Disorders on Outcomes Following Shoulder Arthroplasty

Background: There is conflicting evidence on the impact of mental health on postoperative outcomes following total joint arthroplasty. Specific to shoulder arthroplasty there is a lack of data investigating the correlation between mental health and surgical outcomes. Most studies have focused on patient-reported outcome measures, while few have explored objective clinical outcomes. Additionally, studies that do explore clinical outcomes often fail to control for comorbidities. The purpose of this study is to determine if the presence of a mental health condition is associated with poorer outcomes after shoulder arthroplasty when accounting for covariates.

Methods: A retrospective chart review was performed on patients who underwent primary shoulder arthroplasty between 2007 and 2022 at a single institution. Mental health diagnoses assessed included disorders associated with depression, anxiety, trauma, alcohol-use disorder, bipolar disorder, and schizoid disorders. Multivariable regression modeling was used to control for confounding variables and assess the likelihood of adverse clinical outcomes for patients with mental health disorders. Patient-reported outcome measures were also collected and compared.

Results: 1169 patients underwent shoulder arthroplasty between January 2007 and September 2023 at our institution. After controlling for covariates, all-cause readmission within 90 days was found to be significantly associated with alcohol-related disorders (OR = 3.22 [95% CI, 1.30-7.23], p = .007) and bipolar disorders (OR = 4.21 [95% CI, .88-15.58], p = .043).

Conclusion: After adjusting for covariates, alcohol-related and bipolar disorders may be associated with increased risk of 90-day readmission after shoulder arthroplasty, but further investigation is necessary in order to better assess these effects. No associations were found between any mental health disorders and 90-day reoperation of the same joint, 365-day mortality, or patient-reported outcomes.