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
{"title":"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。","authors":"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","doi":"10.3928/01477447-20240918-01","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Materials and methods: </strong>The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. <i>International Classification of Diseases, Tenth Revision,</i> 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 <i>P</i><.05.</p><p><strong>Results: </strong>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, <i>P</i><.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, <i>P</i><.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, <i>P</i><.0001). Periprosthetic fractures (odds ratio, 1.20; <i>P</i>=.041), dislocation (odds ratio, 1.12; <i>P</i>=.042), and 90-day readmission rates (odds ratio, 1.26; <i>P</i><.001) were significantly higher among patients with a MHD.</p><p><strong>Conclusion: </strong>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. [<i>Orthopedics</i>. 2024;47(6):e303-e310.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e303-e310"},"PeriodicalIF":1.1000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.\",\"authors\":\"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\",\"doi\":\"10.3928/01477447-20240918-01\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Materials and methods: </strong>The Premier Healthcare Database was queried for patients undergoing primary aTSA and rTSA from 2016 to 2020. <i>International Classification of Diseases, Tenth Revision,</i> 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 <i>P</i><.05.</p><p><strong>Results: </strong>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, <i>P</i><.0001), longer mean length of stay (1.95±2.25 days vs 1.61±1.51 days, <i>P</i><.0001), and higher mean total postoperative opioid use (72.00±231.55 morphine milligram equivalents [MMEs] vs 59.32±127.31 MMEs, <i>P</i><.0001). Periprosthetic fractures (odds ratio, 1.20; <i>P</i>=.041), dislocation (odds ratio, 1.12; <i>P</i>=.042), and 90-day readmission rates (odds ratio, 1.26; <i>P</i><.001) were significantly higher among patients with a MHD.</p><p><strong>Conclusion: </strong>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. 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Preoperative Mental Health Disorders Affect Opioid Consumption and Perioperative Complications After Total Shoulder Arthroplasty.
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.].
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.
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