Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.

IF 1.1 4区医学 Q3 ORTHOPEDICS

Orthopedics Pub Date : 2024-11-01 Epub Date: 2024-09-23 DOI:10.3928/01477447-20240918-01

Cory K Mayfield, Maya S Abu-Zahra, Ioanna K Bolia, Jacob L Kotlier, Eric H Lin, Seth C Gamradt, Alexander E Weber, Joseph N Liu, Frank A Petrigliano

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引用次数: 0

Abstract

Background: Limited evidence exists regarding the influence of mental health disorders (MHDs) on opioid use and complications after total shoulder arthroplasty (TSA). We aimed to identify the prevalence of common MHDs among patients undergoing anatomic TSA (aTSA) and reverse TSA (rTSA).

Materials and methods: The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. International Classification of Diseases, Tenth Revision, diagnosis codes were used to identify MHDs. Primary outcomes included the prevalence of MHDs, perioperative opioid consumption, and 90-day risk of postoperative complications, revision, and readmission. Bivariate and multivariate regression analyses were performed to assess 90-day risk of primary endpoints while controlling for potential confounders. Statistical significance was defined as P<.05.

Results: From 2016 to 2020, 49,997 of 144,725 (34.55%) patients undergoing primary TSA had at least one diagnosed MHD. The most prevalent were depression (17.03%), anxiety (16.75%), and substance use disorder (10.20%). Patients with a MHD had higher mean hospital costs ($75,984±$43,129 vs $73,316±$39,046, P<.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, P<.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, P<.0001). Periprosthetic fractures (odds ratio, 1.20; P=.041), dislocation (odds ratio, 1.12; P=.042), and 90-day readmission rates (odds ratio, 1.26; P<.001) were significantly higher among patients with a MHD.

Conclusion: This study found that MHDs are associated with significantly increased perioperative opioid consumption, medical and surgical complication rates, and risk of readmission after TSA. Recognition and optimization of MHDs is critical to minimizing complications and opioid consumption after TSA. [Orthopedics. 2024;47(6):e303-e310.].

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术前心理健康障碍会影响全肩关节置换术后阿片类药物的用量和围手术期并发症。

背景：有关心理健康障碍（MHD）对阿片类药物使用和全肩关节置换术（TSA）后并发症的影响的证据有限。我们旨在确定接受解剖型 TSA（aTSA）和反向 TSA（rTSA）的患者中常见 MHD 的患病率：在 Premier Healthcare 数据库中查询了 2016 年至 2020 年期间接受初诊 aTSA 和 rTSA 的患者。国际疾病分类第十版》诊断代码用于识别 MHD。主要结果包括 MHD 的发病率、围手术期阿片类药物的消耗量以及术后 90 天并发症、复发和再入院的风险。在控制潜在混杂因素的同时，进行了二元和多元回归分析，以评估主要终点的 90 天风险。统计显著性定义为PResults：从 2016 年到 2020 年，144,725 名接受初级 TSA 的患者中有 49,997 人（34.55%）至少诊断出一种 MHD。最常见的是抑郁症（17.03%）、焦虑症（16.75%）和药物使用障碍（10.20%）。MHD患者的平均住院费用（75,984美元±43,129美元 vs 73,316美元±39,046美元，PPPP=0.041）、脱位（几率比1.12；P=0.042）和90天再入院率（几率比1.26；PC结论：本研究发现，MHD与围手术期阿片类药物消耗量、医疗和手术并发症发生率以及TSA术后再入院风险的显著增加有关。识别和优化 MHD 对最大限度减少 TSA 术后并发症和阿片类药物消耗至关重要。[骨科。202x;4x(x):xx-xx]。

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来源期刊

Orthopedics 医学-整形外科

CiteScore

2.20

自引率

0.00%

发文量

160

审稿时长

3 months

期刊介绍： For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice. The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.