Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Shoulder and Elbow Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2019 Jun;28(6S):S146-S153. doi: 10.1016/j.jse.2019.04.012.
The Distress and Risk Assessment Method (DRAM) predicts poor outcomes in spine, hip, and knee surgery. Unlike other areas of orthopedic surgery, DRAM scores are not predictive of lower postoperative patient-reported outcomes after arthroscopic rotator cuff repair (RCR).
As concerns for opioid dependence and abuse grow, the purpose of this study was to analyze the correlation between preoperative DRAM scores, modified Zung scores, and postoperative narcotic use in patients who underwent arthroscopic RCR.
This prospective cohort study identified and enrolled patients >18 years of age with full-thickness rotator cuff tears at a single institution. Patients with prior shoulder surgery, greater than 1-tendon RCR, and preoperative narcotic use were excluded. One-hundred and fifty patients were enrolled, with 114 (76%) completing all preoperative and postoperative questionnaires. Preoperative DRAM scores were collected from every patient. Postoperative narcotic use was evaluated via survey and converted to total morphine equivalents.
Increased preoperative DRAM scores predicted higher postoperative morphine equivalent units (P = .002, r = 0.29). When dividing patients into those <17 or ≥17 on the modified Zung score, 44 of 114 (39%) met criteria for "at risk or depressed." This group showed a statistically significant trend toward higher postoperative morphine equivalent unit intake (P = .004).
Baseline psychological distress (DRAM) can predict narcotic requirements after RCR and serve as a powerful tool to identify patients at risk for increased narcotics requirements postoperatively. In our cohort, 39% of patients showed evidence of baseline depression, which highlights a potential role of the modified Zung score to identify patients in need of preoperative psychological counseling.
困境和风险评估方法（DRAM）可预测脊柱、髋关节和膝关节手术的不良结局。与矫形外科的其他领域不同，DRAM 评分不能预测关节镜肩袖修复（RCR）后的患者术后报告结局较差。
随着对阿片类药物依赖和滥用的担忧增加，本研究旨在分析关节镜 RCR 患者术前 DRAM 评分、改良zung 评分与术后阿片类药物使用之间的相关性。
本前瞻性队列研究在一家医疗机构中确定并招募了年龄>18 岁、有全层肩袖撕裂的患者。排除了既往肩部手术、>1 根肌腱 RCR 和术前使用阿片类药物的患者。共纳入 150 例患者，其中 114 例（76%）完成了所有术前和术后问卷调查。收集每位患者的术前 DRAM 评分。通过问卷调查评估术后阿片类药物使用情况，并转换为总吗啡等效物。
术前 DRAM 评分升高预测术后吗啡等效单位较高（P =.002，r = 0.29）。当将患者按改良 Zung 评分<17 或≥17 分组时，114 例中有 44 例（39%）符合“有风险或抑郁”标准。该组术后吗啡等效单位摄入有统计学显著趋势（P =.004）。
基线心理困扰（DRAM）可预测 RCR 后的阿片类药物需求，并可作为识别术后阿片类药物需求增加风险患者的有力工具。在我们的队列中，39%的患者有基线抑郁的证据，这突出了改良 Zung 评分在识别需要术前心理辅导的患者方面的潜在作用。
