Evaluating the Relationship Between Patients Diagnosed with Anxiety and Depression and Rates of Postoperative Opioid Use in Five of the Most Common Hand Surgeries

Abstract

Purpose

This study compared postoperative opioid utilization between patients with and without preoperative diagnoses of anxiety and/or depression undergoing elective upper-extremity surgery. We hypothesized that patients with these diagnoses would fill more opioid prescriptions within 30 days of surgery than those without.

Methods

We conducted a retrospective analysis using the PearlDiver Mariner Patient Claims Database (2010–2021). Patients undergoing carpal tunnel release, cubital tunnel release, trigger finger release, and epicondylitis surgeries were identified via Current Procedural Technology and International Classification of Diseases-Ninth and Tenth Revision codes. Patients were categorized by diagnosis of depression only, anxiety only, both anxiety and depression, and control. The primary outcome was opioid prescriptions filled within 30 days postsurgery. Descriptive statistics and chi-square tests were employed.

Results

Among 4,166,706 carpal tunnel release patients, 22.4% with a diagnosis of anxiety and/or depression had a higher opioid fill rate (1.85%) than the control group (1.38%). For 1,409,802 trigger finger release patients, 20.7% with a diagnosis of anxiety and/or depression had a higher fill rate (1.62% vs 1.19%). In 913,929 cubital tunnel release patients, 23.0% with a diagnosis of anxiety and/or depression had a higher fill rate (2.41% vs 1.25%). Among 1,645,767 lateral epicondylitis surgeries, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (1.04% vs 0.71%). For 397,916 medial epicondylitis patients, 22.2% with a diagnosis of anxiety and/or depression had a higher fill rate (0.92% vs 0.66%).

Conclusions

Preoperative depression and/or anxiety were linked to higher postoperative opioid prescriptions across all surgeries, emphasizing the need to consider these diagnoses in opioid prescribing.

Level of evidence

Prognostic IV.