# The Role of Depression in Complications, Functional Recovery, and Healthcare Utilization Following Shoulder Arthroplasty: A Systematic Review of Contemporary Literature

## TL;DR

Depression affects outcomes after shoulder surgery, leading to more complications and higher healthcare use, but patients can still improve with proper care.

## Contribution

This review systematically evaluates the impact of depression on shoulder arthroplasty outcomes using recent, high-quality studies.

## Key findings

- Depressed patients had lower outcome scores and higher complication rates after shoulder surgery.
- Depression was linked to increased healthcare use, including emergency visits and readmissions.
- Despite worse outcomes, depressed patients still showed functional improvement post-surgery.

## Abstract

Depression is increasingly recognized as an important factor influencing outcomes after total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), yet its specific impact remains incompletely defined. This systematic review, conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, synthesized evidence from 14 original studies published in the last decade examining the association between depression and postoperative outcomes following TSA and RSA. Across diverse institutional and national datasets, depressed patients generally demonstrated lower absolute patient-reported outcome scores, though several studies reported comparable relative improvements from baseline. Depression was consistently associated with higher complication rates, including infection, thromboembolic events, and mechanical failure, as well as prolonged opioid use, greater emergency department utilization, increased readmissions, longer length of stay, and higher healthcare costs. Most studies were of moderate to high methodological quality on the Newcastle-Ottawa Scale, with no high-risk studies identified. The findings suggest that depression independently contributes to worse objective and patient-reported outcomes after shoulder arthroplasty, but does not preclude meaningful functional improvement. Routine preoperative depression screening and mental health optimization may represent modifiable targets to enhance surgical recovery, reduce complications, and lower healthcare utilization in this population.