The association of depression and anxiety with postoperative opioid use following total joint arthroplasty

BACKGROUND: The devastating opioid epidemic in the United States has been exacerbated by health care practices as well as underlying individual factors. Total joint arthroplasty (TJA) is one of the most common surgical procedures performed annually and patients frequently require opioids for pain control. Patient anxiety and depression has been shown to be associated with increased pain and poorer outcomes after TJA. Our study sought to determine if there was an association between depression/anxiety and postoperative opioid use following TJA. METHODS: In this retrospective cohort study, postoperative outcomes after TJA were compared among three cohorts of patients: 1) no depression; 2) mild depression; or 3) moderate or severe depression at our institution from 2017 to 2019. Our primary outcome was persistent opioid use ≥3 months after surgery. Secondary outcomes included postoperative day 1 opioid consumption and hospital length of stay (LOS). Multivariable regression modeling was performed to control for various potential confounders. RESULTS: Of the 542 total patients that met inclusion criteria for this study, 53 (9.8%) had mild depression and 67 (12.4%) had moderate or severe depression. Persistent opioid use ≥3 months after surgery was found in 132 (24.3%) patients. Mild depression was associated with increased odds of persistent opioid use (odds ratio 4.11, 95% confidence interval 1.65–10.18, P = 0.002). Depression was not associated with immediate postoperative opioid use or hospital LOS. CONCLUSION: Mild depression was associated with persistent opioid use after surgery. Future studies should investigate if better management of this comorbidity could improve outcomes in patients undergoing joint arthroplasty.