title: The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty.
abstract: BACKGROUND
  Psychiatric comorbidity has been associated with increased health risks and poor long-term treatment outcomes in numerous medical disciplines, but its effect in short-term perioperative settings is incompletely understood. The purpose of this study was to evaluate the influence of a preoperative diagnosis of depressive disorder, anxiety disorder, schizophrenia, or dementia on in-hospital (1) adverse events, (2) blood transfusion, and (3) nonroutine discharge in patients undergoing shoulder arthroplasty.
  
  
  METHODS
  Using the National Hospital Discharge Survey (NHDS) database, we identified 348,824 discharges having undergone partial or total shoulder arthroplasty from 1990 to 2007. Multivariable regression analysis was performed for each of the outcome variables.
  
  
  RESULTS
  The prevalence of diagnosed depressive disorder was 4.4%, anxiety disorder, 1.6%; schizophrenia, 0.6%; and dementia, 1.5%. Preoperative psychiatric disorders, with the exception of schizophrenia, were associated with higher rates of adverse events. Depression and schizophrenia were associated with higher perioperative rates of blood transfusion. Any preoperative psychiatric illness was associated with higher rates of nonroutine discharge.
  
  
  CONCLUSIONS
  Patients with preoperative psychiatric illness undergoing shoulder arthroplasty are at increased risk for perioperative morbidity and posthospitalization care. Preoperative screening of psychiatric illness might help with planning of shoulder arthroplasty.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Arjan G J
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA. Electronic address: dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
mesh_terms: D000328:Adult; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects* / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Psychiatric illness; comorbidities; shoulder arthroplasty