The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty

Rubenstein, William J.; Grace, Trevor; Croci, Rhiannon; Ward, Derek

doi:10.1016/j.artd.2018.07.002

Cited by 22 publications

(6 citation statements)

References 35 publications

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“…Although it is important to be aware of the association between diabetes mellitus and smoking and increased postoperative opioid use, these are largely nonmodifiable risk factors at the time of treatment for acute injuries. In agreement with prior studies, we did not find a significant association between depression, fracture type, or fixation method and postoperative opioid prescription (Rubenstein, Grace, Croci, & Ward, 2018; Strike, Sieber, Gottschalk, & Mears, 2013).…”

Section: Discussionsupporting

confidence: 92%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

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Objective Opioid prescribing after hip fracture fixation is variable, but the factors that drive this prescribing variation are not well‐described. The purpose of this study was to determine independent factors associated with increased opioid prescription upon discharge after hip fracture fixation. Methods A retrospective cohort study of 296 adult patients who underwent hip fracture fixation between January 2016 and December 2017 at two Level I trauma centers were included in our study. The primary outcome measurement was opioid prescription at discharge in morphine milligram equivalents (MME). Bivariate analysis was used to screen for factors, and multivariable regression analysis was used to identify independent factors associated with opioid prescription upon discharge from the hospital. Results Discharge opioid prescription amounts were available for 280 out of 296 patients (95%). The mean (±standard deviation) discharge opioid prescription was 212 (±319) MME. Multivariable regression analysis showed that younger age (p = 0.004), diabetes mellitus (p = 0.02), smoking (p < 0.001), treatment at hospital #2 (p < 0.001), and weekend discharge (p = 0.03) were associated with increased opioid prescription at discharge. Conclusions Increased opioid prescribing after hip fracture fixation is associated with patient‐ and system‐related factors. Prescriber education programs, prescription guidelines, and safe handoff practices that focus on these factors may help to decrease prescription variability and opioid overprescription across institutions.

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Section: Discussionsupporting

confidence: 92%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

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“…Surgical patients with OUD have distinct characteristics and require clinical care that is responsive to their unique needs, including pain and withdrawal management. 9 , 10 Consistent with other literature, we found that surgical patients with OUD were disproportionally insured by Medicaid 4 , 42 and younger, 4 more frequently experienced mental health comorbidities, 43 , 44 and more often had a patient-directed discharge. 45 Our finding that 1.3% of surgical patients had OUD is higher than another population-based study that found 0.6% prevalence, 5 but that study used International Classification of Diseases, Ninth Revision codes that are known to be less sensitive for identifying OUD than the ICD-10 codes that we used.…”

Section: Discussionsupporting

confidence: 89%

Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder

French

McHugh

Aiken

et al. 2022

Annals of Surgery Open

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Objectives: To determine whether better nursing resources (ie, nurse education, staffing, work environment) are each associated with improved postsurgical outcomes for patients with opioid use disorder (OUD). Background: Hospitalized patients with OUD are at increased risk of adverse outcomes. Evidence suggests that adverse postsurgical outcomes may be mitigated in hospitals with better nursing resources, but this has not been evaluated among surgical patients with OUD. Methods: Cross-sectional (2015–2016) data were utilized from the RN4CAST-US survey of hospital nurses, the American Hospital Association Annual Survey of hospitals, and state patient hospital discharge summaries. Multivariate logistic and zero-truncated negative binomial regression models were employed to examine the association between nursing resources and 30-day readmission, 30-day in-hospital mortality, and length of stay for surgical patients with OUD. Results: Of 919,601 surgical patients in 448 hospitals, 11,610 had identifiable OUD. Patients with compared to without OUD were younger and more often insured by Medicaid. Better nurse education, staffing, and work environment were each associated with better outcomes for all surgical patients. For patients with OUD, each 10% increase in the proportion of nurses with a bachelor’s degree in nursing was associated with even lower odds of 30-day readmission (odds ratio [OR] = 0.88; P = 0.001), and each additional patient-per-nurse was associated with even lower odds of 30-day readmission (OR = 1.09; P = 0.024). Conclusions: All surgical patients fare better when cared for in hospitals with better nursing resources. The benefits of having more nurses with a bachelor’s degree and fewer patients-per-nurse in hospitals appear greater for surgical patients with OUD.

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“…[43][44][45] As seen in our study cohort, patients with anxiety and/or depression are also more likely to be taking opioid medication prior to surgery. 13,48 As opioid consumption is associated with undesirable outcomes post-surgery, 15 strategies aimed at reducing opioid consumption pre-surgery may also be relevant.…”

mentioning

confidence: 99%

Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty

Seagrave

Lewin

Harris

et al. 2021

J Orthop Surg (Hong Kong)

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Purpose: While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. Methods: A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. Results: 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a “much better” global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. Conclusion: After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.

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The interaction of depression and prior opioid use on pain and opioid requirements after total joint arthroplasty

Cited by 22 publications

References 35 publications

Factors associated with discharge opioid prescription after hip fracture fixation

Factors associated with discharge opioid prescription after hip fracture fixation

Nursing Resources Linked to Postsurgical Outcomes for Patients With Opioid Use Disorder

Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty

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