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

Patrick P. Nian; Adam M. Gordon; Joydeep Baidya; Chaim Miller; Jack Choueka

doi:10.1055/s-0043-1771340

Journal of Wrist Surgery, Table of Contents

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

¹College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York

,

Adam M. Gordon

²Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York

³Questrom School of Business, Boston University, Boston, Massachusetts

,

Joydeep Baidya

¹College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York

,

Chaim Miller

²Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York

,

Jack Choueka

²Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York

› Author Affiliations

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

Full Text

References

References
1 Tolentino JC, Schmidt SL. DSM-5 criteria and depression severity: implications for clinical practice. Front Psychiatry 2018; 9: 450
2 Kessing LV. Epidemiology of subtypes of depression. Acta Psychiatr Scand Suppl 2007; 115 (433) 85-89
3 Kessler RC, Berglund P, Demler O. et al; National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289 (23) 3095-3105
4 Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatry 1994; 151 (07) 979-986
5 Patten SB. Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low. BMC Psychiatry 2009; 9 (01) 19
6 Bromet E, Andrade LH, Hwang I. et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med 2011; 9 (01) 90
7 Malhi GS, Mann JJ. Depression. Lancet 2018; 392 (10161): 2299-2312
8 Rehm J, Shield KD. Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep 2019; 21 (02) 10
9 Jayakumar P, Overbeek CL, Lamb S. et al. What factors are associated with disability after upper extremity injuries? A systematic review. Clin Orthop Relat Res 2018; 476 (11) 2190-2215
10 Williams AE, Newman JT, Ozer K, Juarros A, Morgan SJ, Smith WR. Posttraumatic stress disorder and depression negatively impact general health status after hand injury. J Hand Surg Am 2009; 34 (03) 515-522
11 McQuillan TJ, Bernstein DN, Merchan N. et al. The association between depression and antidepressant use and outcomes after operative treatment of distal radius fractures at 1 year. J Hand Surg Am 2022; 47 (12) 1166-1171
12 Wilson K, von der Heyde R, Sparks M. et al. The impact of demographic factors and comorbidities on distal radius fracture outcomes. Hand (N Y) 2014; 9 (01) 80-86
13 Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: a latent growth curve analysis. Musculoskelet Sci Pract 2019; 43: 96-102
14 Jayakumar P, Teunis T, Vranceanu AM, Lamb S, Ring D, Gwilym S. Early psychological and social factors explain the recovery trajectory after distal radial fracture. J Bone Joint Surg Am 2020; 102 (09) 788-795
15 Yeoh JC, Pike JM, Slobogean GP, OʼBrien PJ, Broekhuyse HM, Lefaivre KA. Role of depression in outcomes of low-energy distal radius fractures in patients older than 55 years. J Orthop Trauma 2016; 30 (05) 228-233
16 Mahmood B, Golub IJ, Ashraf AM, Ng MK, Vakharia RM, Choueka J. Risk factors for infections following open reduction and internal fixation for distal radius fractures an analysis of the Medicare claims database. Bull Hosp Jt Dis (2013) 2022; 80 (02) 228-233
17 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
18 Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am 2018; 49 (02) 211-222
19 Kazmers NH, Judson CH, Presson AP, Xu Y, Tyser AR. Evaluation of factors driving cost variation for distal radius fracture open reduction internal fixation. J Hand Surg Am 2018; 43 (07) 606-614.e1
20 Childs S, Mann T, Dahl J. et al. Differences in the treatment of distal radius fractures by hand fellowship trained surgeons: a study of ABOS candidate data. J Hand Surg Am 2017; 42 (02) e91-e97
21 Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 2011; 36 (05) 824-35.e2
22 Mosenthal WP, Boyajian HH, Ham SA, Conti Mica MA. Treatment trends, complications, and effects of comorbidities on distal radius fractures. Hand (N Y) 2019; 14 (04) 534-539
23 Daley E, Peek K, Carlin K. et al; CoULD Study Group. Effect of race and geography on patient- and parent-reported quality of life for children with congenital upper limb differences. J Hand Surg Am 2023; 48 (03) 274-282
24 Kind AJH, Buckingham WR. Making neighborhood-disadvantage metrics accessible - the neighborhood atlas. N Engl J Med 2018; 378 (26) 2456-2458
25 Stonner MM, Keane G, Berlet L, Goldfarb CA, Pet MA. The impact of social deprivation and hand therapy attendance on range of motion after flexor tendon repair. J Hand Surg Am 2022; 47 (07) 655-661
26 Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46 (03) 399-424
27 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861
28 Siu AL, Bibbins-Domingo K, Grossman DC. et al; US Preventive Services Task Force (USPSTF). Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA 2016; 315 (04) 380-387
29 Goudie ST, Broll R, Warwick C, Dixon D, Ring D, McQueen M. The association between psychological factors and outcomes after distal radius fracture. J Hand Surg Am 2022; 47 (02) 190.e1-190.e10
30 Scarone P, Van Santbrink W, Koetsier E, Smeets A, Van Santbrink H, Peters ML. The effect of perioperative psychological interventions on persistent pain, disability, and quality of life in patients undergoing spinal fusion: a systematic review. Eur Spine J 2023; 32 (01) 271-288
31 Parrish JM, Jenkins NW, Parrish MS. et al. The influence of cognitive behavioral therapy on lumbar spine surgery outcomes: a systematic review and meta-analysis. Eur Spine J 2021; 30 (05) 1365-1379
32 Pellino TA, Gordon DB, Engelke ZK. et al. Use of nonpharmacologic interventions for pain and anxiety after total hip and total knee arthroplasty. Orthop Nurs 2005; 24 (03) 182-190 , quiz 191–192
33 Szeverenyi C, Kekecs Z, Johnson A, Elkins G, Csernatony Z, Varga K. The use of adjunct psychosocial interventions can decrease postoperative pain and improve the quality of clinical care in orthopedic surgery: a systematic review and meta-analysis of randomized controlled trials. J Pain 2018; 19 (11) 1231-1252
34 Schwartz AM, Wilson JM, Farley KX, Roberson JR, Guild III GN, Bradbury Jr TL. Modifiability of depression's impact on early revision, narcotic usage, and outcomes after total hip arthroplasty: the impact of psychotherapy. J Arthroplasty 2020; 35 (10) 2904-2910
35 Sumner K, Grandizio LC, Gehrman MD, Graham J, Klena JC. Incidence and reason for readmission and unscheduled health care contact after distal radius fracture. Hand (N Y) 2020; 15 (02) 243-251
36 Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am 2010; 35 (06) 956-960
37 Nasser JS, Chou CH, Chung KC. Thirty-day emergency department utilization after distal radius fracture treatment: identifying predictors and variation. Plast Reconstr Surg Glob Open 2019; 7 (09) e2416
38 Curtin CM, Hernandez-Boussard T. Readmissions after treatment of distal radius fractures. J Hand Surg Am 2014; 39 (10) 1926-1932
39 Gordon AM, Malik AT, Goyal KS. Trends of hand injuries presenting to US emergency departments: a 10-year national analysis. Am J Emerg Med 2021; 50: 466-471
40 Jayakumar P, Teunis T, Vranceanu AM. et al. The impact of a patient's engagement in their health on the magnitude of limitations and experience following upper limb fractures. Bone Joint J 2020; 102-B (01) 42-47