Hessburg LT, Ziedas AC, Cross AG, Elhage K, Yedulla N, Koolmees D, Muh SJ, Moutzouros V, and Makhni EC. Patients with Preoperative Clinical Depression Symptomology Experience Significant Improvements in Postoperative Pain, Function, and Depressive Symptoms Following Rotator Cuff Repair. Arthroscopy 2021.
PURPOSE: To determine the impact of clinical depression on outcomes following rotator cuff repair (RCR), as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) health domains.
METHODS: RCR patients were given PROMIS CAT assessments for physical function (PROMIS UE), pain interference (PROMIS PI), and depression (PROMIS D) during pre- and postoperative clinic visits. PROMIS D scores ≥ 55 correlate with mild clinical depression; thus, patients with PROMIS D scores ≥ 55 were placed in the "clinical depression" (CD) group, while patients with scores "no clinical depression" (NCD) group. Categorical variables were compared at preoperative and postoperative (6m and ≥1y) timepoints using chi-squared tests. Continuous variables were compared using student's t-tests.
RESULTS: Of the 340 RCR patients included in this study, 65 (19.1%) were found to have mild clinical depression preoperatively, with that number being reduced to 23 (6.8%) at 6m and 19 (5.6%) at ≥1y postoperatively. Compared with preoperative PROMIS scores, CD patients had significant postoperative improvements at 6m and ≥1y in mean PROMIS UE (26.7 vs 35.5 vs 38.9; p<.001) and PROMIS PI (67.6 vs 56.7 vs 56.4; p<.001). NCD patients had similar postoperative improvements at 6m and ≥1y in mean PROMIS UE (30.8 vs 38.6 vs 46.9; p<.001) and PROMIS PI (61.7 vs 53.0 vs 47.6; p<.001). The improvement in PROMIS scores was similar for the CD and NCD groups in both PROMIS UE (12.2 vs 16.1, respectively) and PROMIS PI (-11.2 vs -14.1, respectively).
CONCLUSION: Despite starting with worse PROMIS UE and PROMIS PI scores, patients undergoing RCR with symptoms of CD experienced significant improvement in function, pain, and depressive symptoms. Preoperative depression should not be a contraindication to arthroscopic RCR in patients who are otherwise appropriate operative candidates.
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