Preoperative Acute Depressive Episodes are Associated with Increased Medication Prescribing and Inpatient Services Following Primary Arthroscopic Rotator Cuff Repair.
Brandon J Martinazzi, Peter F Monahan, Benjamin Miltenberg, William L Johns, Paige E Faasuamalie, Michael C Aynardi, Surena Namdari, Michael G Ciccotti
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Abstract
Purpose: The purpose of this study is to compare postoperative healthcare utilization, prescriptions, and shoulder surgery between patients with an acute depressive episode (ADE) and those without an acute depressive episode (NADE) within 3 months before arthroscopic rotator cuff repair.
Methods: Diagnostic and procedural codes were used to identify patients in the TriNetX Research Network at least 18 years of age and underwent arthroscopic rotator cuff repair between January 2010 and November 2021. Patients with a previous rotator cuff repair or diagnosis of recurrent major depressive disorder were excluded. Patients were stratified into ADE and NADE cohorts and propensity matched. Outcomes were measured by healthcare utilization and medication prescribing up to 3 months and incidence of future shoulder surgery up to 2 years postoperatively.
Results: After propensity matching, the ADE cohort included 1,514 patients and were compared to 1,514 patients in the NADE cohort. Preoperative characteristics were similar including female sex (62.1 % and 63.0% respectively, P = 0.599). A greater percentage of the ADE cohort received inpatient services within 3 months (4.5% vs 3.0%, OR 1.54; CI 1.05-2.25, P = 0.027) following surgery. Patients with ADE were prescribed a greater percentage of antidepressants (32.8% vs 24.4%, OR 1.51, 95% CI 1.29-1.77, P < 0.0001), sedatives (25.2% vs 20.5%, OR 1.31, CI 1.11-1.55, P = 0.002), and opioid analgesics (63.4% vs 55.7%, OR 1.38 CI 1.19-1.59) P < 0.0001) within 3 months. Within 2 years, incidence of future surgery were similar for arthroscopy (7.9% vs 7.3%) and arthroplasty (2.2% vs 1.6%).
Conclusion: Acute depressive episodes prior to primary arthroscopic rotator cuff repair are associated with increased utilization of inpatient services and postoperative analgesic prescriptions. Incidence of future shoulder surgery for arthroscopy and arthroplasty was similar between patients with or without ADEs.
目的：本研究的目的是比较关节镜下肩袖修复前3个月内有急性抑郁发作（ADE）和没有急性抑郁发作（NADE）的患者的术后保健利用、处方和肩部手术。方法：使用诊断和程序代码识别在TriNetX研究网络中至少18岁并在2010年1月至2021年11月期间接受关节镜下肩袖修复的患者。既往有肩袖修复或诊断为复发性重度抑郁症的患者被排除在外。将患者分为ADE组和NADE组，并进行倾向匹配。通过3个月的医疗保健利用和药物处方以及术后2年的未来肩部手术发生率来衡量结果。结果：倾向匹配后，ADE队列包括1,514例患者，与NADE队列的1,514例患者进行比较。术前特征相似，包括女性（分别为62.1%和63.0%,P = 0.599）。在3个月内接受住院治疗的ADE患者比例更高(4.5% vs 3.0%, OR 1.54；CI 1.05-2.25, P = 0.027)。ADE患者在3个月内服用抗抑郁药（32.8% vs 24.4%, OR 1.51, 95% CI 1.29-1.77, P < 0.0001）、镇静剂（25.2% vs 20.5%, OR 1.31, CI 1.11-1.55, P = 0.002）和阿片类镇痛药（63.4% vs 55.7%, OR 1.38 CI 1.19-1.59） P < 0.0001)的比例更高。2年内，关节镜和关节置换术的未来手术发生率相似（分别为7.9%和7.3%）。结论：原发性关节镜下肩袖修复前的急性抑郁发作与住院服务和术后镇痛处方的使用率增加有关。未来肩关节镜手术和关节置换术的发生率在有或没有ade的患者中相似。
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