(285) Preoperative depression and anxiety as predictors of persistent opioid use after orthopedic surgery: A retrospective claims-based analysis

Background: : Psychiatric conditions such as depression and anxiety affect nearly 20% of U.S. adults and may predispose surgical patients to adverse postoperative outcomes. Persistent opioid use (POU), defined as continued use of opioids 3 months after surgery, is an emerging concern in the postoperative setting, yet the association of preoperative psychiatric disorders to POU remains understudied.

Objective: : To evaluate if there is an association between preoperative depression or anxiety and POU in patients undergoing orthopedic surgery, using inverse probability of treatment weighting (IPTW) to adjust for confounding

Methods: : We conducted a retrospective cohort study using administrative claims data. Eligible patients were opioid-naïve adults undergoing hip fracture repair, joint replacement, or spine surgery between 2017-2022. Opioid-naïve was defined as no opioid fills 31–180 days pre-op and ≥1 fill 30 days before to 7 days after surgery. Patients required continuous enrollment ≥365 days pre- and ≥180 days post-op. The primary variable of interest was pre-op diagnosis of depression or anxiety (ICD-10-CM within 6 months pre-op). The outcome, POU, was ≥1 opioid fill on days 91–180 post-op.
Propensity scores were estimated using multinomial logistic regression. IPTW was used to balance baseline characteristics for patients with and without pre-op depression or anxiety. Covariate balance was assessed with standardized mean differences (SMD < 0.1). Weighted multivariable logistic regression evaluated the association between pre-op depression or anxiety and POU. Sensitivity analyses tested alternative POU definitions (91–120 days), extended lookback windows, cancer patient exclusion, and IPTW comparison with regression.

Results: : Among 314,105 patients, 11.1% developed POU. After IPTW, patients with preoperative anxiety only (aOR: 1.22; 95% CI: 1.17–1.26; p< 0.001), depression only (aOR: 1.27; 95% CI: 1.22–1.32; p< 0.001), or both conditions (aOR: 1.40; 95% CI: 1.35–1.46; p< 0.001), and females (aOR: 1.09; 95% CI: 1.05-1.1; p< 0.001) had significantly higher odds of POU. Each year of increased age reduced the risk of POU (aOR: 0.995; 95% CI: 0.994-0.997; p< 0.001). Sensitivity analyses produced consistent findings, with minor changes in effect size due to differences in sample size.

Conclusions: : Preoperative depression and anxiety are associated with increased risk of POU following orthopedic surgery, even after adjustment for confounding. These findings show the importance of integrating mental health screening and support into both preoperative and postoperative care pathways.

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