Mental health disorders may increase opioid consumption, complications after TSA
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Key takeaways:
- Patients with mental health disorders may be at increased risk for poor outcomes after shoulder arthroplasty.
- Mental health disorders were associated with increased postoperative opioid use and complications.
According to published results, preoperative mental health disorders may be associated with increased opioid consumption, complications and costs for patients undergoing total shoulder arthroplasty.
Using the Premier Healthcare Database, Cory K. Mayfield, MD, and colleagues performed a study of data from 144,725 patients who underwent TSA between 2016 and 2020 to assess the impact of mental health disorders on outcomes such as opioid consumption, complications, revisions and readmissions. According to the study, opioid consumption was measured in morphine milligram equivalents (MMEs).
Among the cohort, 34.55% of patients had at least one diagnosed mental health disorder and 13.3% of patients had multiple diagnosed mental health disorders. The most common mental health disorders were depression (17.03%), anxiety (16.75%) and substance use disorder (10.2%).
At 90 days, patients with mental health disorders had higher mean hospital costs ($75,984 vs. $73,316), longer mean length of stay (1.95 days vs. 1.61 days) and higher mean postoperative opioid use (72 MMEs vs. 59.32 MMEs) compared with patients without mental health disorders.
Mayfield and colleagues also found patients with mental health disorders were at increased risk for periprosthetic fractures (OR = 1.2), dislocations (OR = 1.12) and readmissions (OR = 1.26) at 90 days compared with patients without mental health disorders.
Mayfield and colleagues also noted postoperative opioid consumption increased with each additional diagnosis of a mental health disorder.
“As the prevalence of [mental health disorders] MHDs after the COVID-19 pandemic continues to increase, our study builds on preexisting evidence by demonstrating that patients with a wide spectrum of mental health conditions are at increased risk for numerous postoperative surgical and medical complications,” Mayfield and colleagues wrote in the study. “Recognition and optimization of mental health conditions is critical to minimizing complications and opioid consumption after TSA,” they concluded.
Perspective
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The study by Cory K. Mayfield, MD, and colleagues highlights the influence of mental health disorders on outcomes, including complications and revision rates, after anatomic and reverse total shoulder arthroplasty. The authors mined a large recent database to explore this relationship. The authors found that various complications occurred at a higher rate in patients with mental health disorders than in patients without these disorders. In addition, the study found that patients with mental health disorders had significantly higher postoperative opioid consumption than those without these disorders.
However, this study was unable to determine the influence of preoperative opioid use on these results. In addition, there clearly was a large variability in opioid consumption for specific mental health disorders, such as substance use disorder, accounting for large standards of deviation. Patients with substance use disorder may have included those who had abstained from opioids and heavy consumers of opioids perioperatively. In addition, opioid use may have been influenced by potential confounders that were not assessed, such as the use of preoperative regional anesthesia.
The study calls our attention to recognizing mental health disorders preoperatively, but more granular study, perhaps restricted to one of the more common mental health disorders, such as anxiety, depression or substance use disorder, is needed to provide further clinical guidance.
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