Arthroscopic rotator cuff repair outcomes are typically characterized by radiographic findings, physical function, and patient-reported outcome measures. Now, Cale Jacobs, PhD, of the Division of Sports Medicine in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, and colleagues at the University of Kentucky have measured the utilization of treatment for depression and anxiety after arthroscopic rotator cuff repair.</p>
In Arthroscopy, they show that many—not all—patients with comorbid depression and/or anxiety who undergo rotator cuff repair have a decreased need for pharmaceutical treatment and psychotherapy during the year after surgery.
Methods
The data source for the study was the Truven Healthcare MarketScan database, which contains commercial and Medicare supplemental claims information for more than 135 million unique individuals.
The study period was from January 2009 to December 2016. The team identified 170,406 patients who underwent rotator cuff repair, and 46,737 of them (56% female) had claims related to depression and/or anxiety during the year before surgery.
Medication
Of the 46,737 patients diagnosed with depression or anxiety preoperatively:
9,173 (20%) filled a related prescription at least once in the year before surgery
- 41% of those patients did not take medication for depression or anxiety during the year after surgery
- 33% continued medication but showed a median 30-day reduction in the number of days of medication
- 26% maintained or increased their medication doses
37,564 (80%) were not treated with medication before surgery
- 95% continued to not use medication for depression or anxiety after surgery
- 5% began using medication
Psychotherapy
Of all 46,737 patients studied:
6,119 (13%) attended psychotherapy sessions in the year before surgery
- 49% of those patients stopped psychotherapy during the year after surgery
- 28% reduced the number of sessions
- 23% maintained or increased their number of sessions
40,618 (87%) were not in psychotherapy before surgery
- 95% continued to not attend psychotherapy after surgery
- 5% began psychotherapy
Clinical Perspective
Symptoms of depression or anxiety prior to rotator cuff repair are often associated with poorer outcomes after surgery when compared to those without depression or anxiety. However, symptoms of depression or anxiety may lessen for some when the source of chronic pain is successfully treated. That said, for those with symptoms of depression or anxiety that persist after surgery, surgery practices should be aware that including a behavioral psychologist and/or psychiatrist in the multidisciplinary treatment plan may be appropriate.