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Original article
Risk factors for new-onset depression or anxiety following total joint arthroplasty: the role of chronic opioid use
  1. Lauren Wilson1,
  2. Janis Bekeris1,2,
  3. Megan Fiasconaro1,
  4. Jiabin Liu1,3,
  5. Jashvant Poeran4,5,
  6. David H Kim1,3,
  7. Alejandro Gonzalez Della Valle6 and
  8. Stavros G Memtsoudis1,2,3,7
  1. 1 Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, New York, USA
  2. 2 Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
  3. 3 Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States
  4. 4 Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  5. 5 Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  6. 6 Department of Orthopedic Surgery, Hospital for Special Surgery, New York City, New York, USA
  7. 7 Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, United States
  1. Correspondence to Dr Stavros G Memtsoudis, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York City, NY 10021, USA; memtsoudiss{at}hss.edu

Abstract

Background Several studies have evaluated the impact of preoperative depression on outcomes following total joint arthroplasty (TJA), however few have studied new-onset depression or anxiety after TJA. We aimed to identify the incidence of and risk factors for new-onset depression/anxiety after TJA, specifically focusing on the role of chronic opioid use.

Methods Patients who underwent total hip (THA) or total knee (TKA) arthroplasty from 2012 to 2015 were identified from the Truven MarketScan database. The main outcomes were new-onset depression or anxiety. The main risk factor of interest was chronic opioid use as a proxy for chronic pain; this was classified into three groups: isolated preoperative use, isolated postoperative use, and preoperative use that continued postoperatively. Multivariable logistic regression models were used to obtain ORs and 95% CIs.

Results Overall, 106 260 TJA procedures were included (34.3% THA/65.7% TKA); new-onset depression and anxiety were observed in 3.6% and 4.8% of patients, respectively. Preoperative chronic opioid use (6.3%; OR 1.88, 95% CI 1.47 to 2.40), isolated postoperative use (10%; OR 2.61, 95% CI 2.08 to 3.28), and continued postoperative use (7.8%; OR 2.08, 95% CI 1.74 to 2.49) were all associated with significantly increased odds of new-onset depression. Additional risk factors included female gender, younger age, comorbid psychological conditions, and hospital readmission within 6 months of surgery. Similar patterns were seen for new-onset anxiety.

Discussion Given the observed relationship between chronic opioid use and adverse psychological outcomes following TJA, the relationship between these two entities requires further evaluation, specifically to identify if there is a causal relationship.

  • depression
  • anxiety
  • arthroplasty
  • chronic pain
  • risk factors

https://doi.org/10.1136/rapm-2019-100785

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    Footnotes

    • Contributors LW helped in study design/planning, data analysis, interpretation of results, manuscript preparation and review. JB, MF, JL, DHK and AGDV helped in study design/planning, interpretation of results and manuscript review. JP and SM helped in study design/planning, interpretation of results, manuscript preparation and review.

    • Funding This study was funded internally by the Department of Anesthesiology, Hospital for Special Surgery, New York, NY.

    • Competing interests SM is a director on the boards of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Society of Anesthesia and Sleep Medicine (SASM). He is a one-time consultant for Sandoz and Teikoku and is currently on the medical advisory board of HATH. He has a pending US Patent application for a Multicatheter Infusion System (US-2017-0361063). He is the owner of SGM Consulting and co-owner of FC Monmouth. None of the above relations influenced the conduct of the present study.

    • Patient consent for publication Not required.

    • Ethics approval Approval for this study was obtained from the Institutional Review Board of Hospital for Special Surgery (IRB No 2017-0169).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available.