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American Association for Hand Surgery

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Preoperative Depression and Anxiety Predict Increased Risk of Complications in CMC Arthroplasty
John T Hurt, BS1, Roy Toston, BS2, Alex Dawes, BS3, Eric R. Wagner, MD1 and Michael Gottschalk, MD4, (1)Emory University, Atlanta, GA, (2)Emory University School Medicine, Atlanta, GA, (3)Emory University School of Medicine, Atlanta, GA, (4)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA

INTRODUCTION: The aim of this study was to investigate preoperative depression and anxiety and their association with complications following CMC arthroplasty. We hypothesized that these comorbid conditions increase a patient's risk for complications, such as infection and prolonged surgical pain.

METHODS: The Truven Marketscan database was utilized to select all patients who underwent CMC arthroplasty from 2010 to 2016 based on Current Procedural Terminology (CPT) codes. Preoperative comorbidities were collected using International Classification of Diseases (ICD) 9/10 codes and selected patients were sorted into cohorts based on preoperative diagnosis of depression and anxiety. Chi-squared, univariate, and multivariate analyses were performed to determine association of these comorbidities with other characteristics and common postoperative complications of CMC arthroplasty to generate the reported odds ratios.

RESULTS: Overall, 29,895 patients underwent CMC arthroplasty from 2010 to 2016 and were included in this study. Those with preoperative depression were found to have the greatest increased odds of developing prolonged postoperative pain (OR: 1.33), infection (OR: 1.41), opioid overdose (OR: 4.31), and engaging in self-harming behavior in the postoperative period (OR: 8.35). Increased odds for overall ED visit (OR: 1.40) and ED visit for pain (OR:2.12) were found in this cohort.

DISCUSSION/CONCLUSION: This study highlights the relationship between preoperatively diagnosed depression and anxiety and increased risk of complications encountered by this population. These include risk of prolonged postoperative pain, infection, and opioid overdose following arthroplasty for CMC arthritis. Mitigation of these risks may be achieved with thorough understanding of a patient's mental health history and appropriate preoperative planning.

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