Defence Research and Development Organisation

The purpose of this study was to evaluate the incidence of new-onset anxiety and depression (NOAD) in younger patients undergoing common sports medicine procedures, determine risk factors associated with NOAD, and identify which treatments are used. A retrospective review of the PearlDiver national database was done. All patients included had no diagnosis of depression or anxiety before undergoing the following surgical procedures: anterior cruciate ligament reconstruction (ACLR), meniscus repair, hip arthroscopy (HA), shoulder instability repair, rotator cuff repair, or Achilles tendon repair. All patients were 25 years or younger and had ≥1-year follow-up. The primary outcome was development of NOAD within 1 year postoperatively. Multivariate regression was used to assess risk factors for NOAD. A total of 178,759 patients were included in this study. Overall, 8,900 (5.0%) of patients developed NOAD within 1 year postoperatively; HA patients had the highest rate of NOAD (8.43%). Logistic regression identified age (P < 0.001), female sex (P < 0.001), Charlson Comorbidity Index score (P < 0.001), alcohol disorders (P < 0.001), headaches/migraines (P < 0.001), obesity (P < 0.001), and tobacco use (P < 0.001) as predictors of NOAD. Compared with ALCR, HA patients (OR, 1.81; P < 0.001) had the greatest risk of developing NOAD. The incidence of NOAD in the first year after common sports medicine procedures was 5% for patients aged 25 years or younger. Increased age, substance use, comorbidities, and HA were identified as risk factors for NOAD. Additional study of both mental health and functional outcomes, prevention, and treatment strategies is required to elucidate the risk of NOAD.

Pediatric cardiac fitness and rehabilitation for patients with congenital heart disease is an emerging yet underdeveloped field. Adult cardiac rehabilitation programs prescribe 36 sessions, but there are no data regarding the ideal number for a pediatric cardiac fitness program (CFP). This study explored whether there was an optimal range of fitness sessions associated with significant gains following a CFP. Pediatric CFP data from January 2017 to December 2022 were analyzed. Number of supervised fitness sessions were categorized into 4 groups (6-11, 12-18, 19-24, and 25-40 sessions) and also analyzed as a continuous variable. Cardiorespiratory fitness, strength, flexibility, and mindset outcome metrics were compared using 1-way analysis of covariance and linear regression, adjusting for baseline values. A total of 62 patients, with median age of 15.5 years (range: 8-21, 50% female), participated in a median of 19 fitness sessions (range: 6-40). Baseline characteristics, congenital heart disease classification, hemodynamic level, and number of sessions/weeks across the 4 groups were similar. Patients improved from pre- to post-CFP in cardiorespiratory fitness, strength, flexibility, and mindset metrics, but no significant differences were found between any of the ranges of sessions or numbers of sessions as a continuous variable. Power was limited due to small sample sizes per group. Fitness improvements were seen with fewer than 36 sessions, but an optimal dose for a complete program remains unclear. Rethinking program completion as achieving goals rather than a specified number of sessions should be considered. Individualized, personal dosing may yield the most efficient use of patient time and health care resources.