Preoperative Depression, Anxiety, and ADHD Predict Complications in Patients Undergoing Carpal Tunnel Release
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: In this study we aimed to investigate the association between preoperatively diagnosed depression, anxiety, and ADHD and postoperative complications following surgical release for carpal tunnel syndrome. We hypothesized that a positive history of comorbid depression, anxiety, or ADHD was associated with increased odds of common complications, such as infection, prolonged surgical pain, and hospital readmission.
METHODS: Using the Truven Marketscan claims database, we identified all patients who underwent surgical release for carpal tunnel syndrome from 2010 to 2017 based on the corresponding Current Procedural Terminology (CPT) codes. ICD 9/10 codes were also utilized to collect patient characteristics and comorbidities. These data were then used to sort the patients into cohorts based on preoperative diagnosis of depression, anxiety, and ADHD.
Descriptive statistical analysis was performed to investigate the relationships between these diagnoses and other comorbidities, as well as their association with common postoperative complications following carpal tunnel release. Multivariate analysis was performed to generate odds ratios for these complications, which were reported with 95% confidence intervals.
RESULTS: A total of 391,277 patients underwent carpal tunnel release during the study window and were included in the analysis. Chi-square testing revealed significant differences in complications between those with and without depression, anxiety, or ADHD . Multivariate analysis revealed the greatest wide-spread odds of complication associated with preoperative depression, most significantly opioid overdose (OR: 2.54), ED visit (OR: 1.48), wound complication (OR: 1.46), sepsis (OR:1.38), and infection (OR: 1.37). In those patients with anxiety, greatest odds of complication were postoperative pain (OR: 1.37) and recurrent lesion of the median nerve (OR: 1.28). Greatest odds of postoperative complication associated with preoperative ADHD were wound-specific complication (OR:1.40) and prolonged pain (OR: 1.35).
CONCLUSION: A history of depression, anxiety, or ADHD is associated with increased odds of certain complications following carpal tunnel release, such as opioid overuse, prolonged pain, infection, and ED visit following surgery. Though the odds appear greatest with depression, each of these conditions places additional burden on the patient and the care team, and must be accounted for during preoperative planning to minimize risk.
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