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J Wrist Surg 2024; 13(05): 432-438
DOI: 10.1055/s-0043-1771340
Scientific Article

Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder

Patrick P. Nian
1   College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
,
Adam M. Gordon
2   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
3   Questrom School of Business, Boston University, Boston, Massachusetts
,
Joydeep Baidya
1   College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
,
Chaim Miller
2   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Jack Choueka
2   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
› Author Affiliations
Funding None.
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Abstract

Background It is unclear whether nonpharmacologic intervention for depressive disorder (DD) in the preoperative period can prevent postoperative complications in hand surgery patients.

Questions/Purpose The aims were to evaluate whether psychotherapy visits/depression screenings within 90 days of open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) were associated with lower rates of (1) medical complications and (2) health care utilization (emergency department [ED] visits and readmissions).

Methods A retrospective analysis of an administrative claims database from 2010 to 2021 was performed. DD patients who underwent ORIF for DRF were 1:5 propensity score matched by comorbidities, including those who did (n = 8,993) and did not (n = 44,503) attend a psychotherapy visit/depression screening 90 days before surgery. Multivariate logistic regression models were constructed to compare the odds ratio (OR) of medical complications, ED visits, and readmissions within 90 days. The p-values less than 0.001 were significant.

Results DD patients who did not attend a preoperative psychotherapy visit/depression screening experienced fivefold higher odds of total medical complications (25.66 vs. 5.27%; OR: 5.25, p < 0.0001), including surgical site infections (1.23 vs. 0.14%; OR: 8.71, p < 0.0001), deep wound infections (0.98 vs. 0.17%; OR: 6.00, p < 0.0001), and transfusions (1.64 vs. 0.22%; OR: 7.61, p < 0.0001). Those who did not attend a psychotherapy visit/depression screening experienced higher odds of ED utilizations (9.71 vs. 2.71%; OR: 3.87, p < 0.0001), however, no difference in readmissions (3.40 vs. 3.54%; OR: 0.96, p = 0.569).

Conclusion Depression screening may be a helpful preoperative intervention to optimize patients with DD undergoing hand surgery to minimize postoperative complications and health care utilization.

Level of Evidence Level III.

Keywords

psychotherapy - screening - depression - depressive disorder - open reduction and internal fixation - distal radius fracture - medical complication - health care utilization

Ethical Committee

This study was determined to be exempt from the Institutional Review Board of Maimonides Medical Center.




Publication History

Received: 02 May 2023

Accepted: 28 June 2023

Article published online:
25 July 2023

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