Impact of Preoperative Anxiety and Depression on Chronic Postoperative Opioid Use in Orthopedic Surgery Patients

OBJECTIVES: To evaluate the association between preoperative depression or anxiety and chronic postoperative opioid use in adults (≥18 years) after orthopedic surgeries.

METHODS: This retrospective cohort study utilized Inovalon closed claims data to examine adults who underwent orthopedic surgeries, identified by CPT codes, from January 2017 to February 2022, considering only the first procedure if multiple were present during the study period. The study included opioid-naïve patients with continuous coverage, excluding those with opioid prescriptions from 365 to 31 days pre-surgery, and focused on individuals who filled opioid prescriptions within one month before or one week after surgery. The primary outcome was postoperative chronic opioid use, defined as filling an opioid prescription 91-180 days post-surgery. Preoperative anxiety/depression identified by ≥2 ICD-10 claims, ≥30 days apart, within 6 months pre-surgery. Association of preoperative anxiety/depression with chronic postoperative opioid use analyzed using multivariable logistic regression, controlling for confounders.

RESULTS: Of the 200,049 adults who underwent orthopedic surgeries, 158,875 had opioids dispensed either 1-month prior or 1-week post-surgery and were included in the final analysis. Of these, 13.1% developed chronic postoperative opioid use. Preoperative anxiety or depression was absent in 74.5%, while 16.0% had either condition, and 9.5% had both. Multivariable logistic regression models revealed that patients with either pre-operative anxiety (adjusted odds ratio [aOR]=1.18; 95%CI 1.14-1.23; p<0.001) or depression (aOR=1.21; 95%CI 1.16-1.26; p<0.001) had 18% or 21% increased risk of chronic opioid use post-surgery, respectively, and those with both conditions had a 29% increased risk (aOR=1.29; 95% CI 1.23-1.36; p<0.001).

CONCLUSIONS: Our study indicates an increased risk of chronic postoperative opioid use in orthopedic surgery patients with preoperative anxiety or depression. To reduce this risk, perioperative mental health interventions, such as cognitive behavioral therapy, and exploring non-opioid alternatives are recommended, although complete avoidance of opioids may not always be feasible.