Post-traumatic stress disorder is associated with increased rates of opioid prescriptions following primary total shoulder arthroplasty: a propensity-matched analysis.

BACKGROUND

Lifetime prevalence of mental health disorders is estimated at 50% within the population of the United States. Among these mental health disorders, there are limited data available on patients with post-traumatic stress disorder (PTSD) following total shoulder arthroplasty (TSA). The aim of this study was to elucidate postoperative complications, adverse outcomes, and healthcare utilization in patients with a pre-existing diagnosis of PTSD compared to those without PTSD.

METHODS

The TriNetX database was queried to identify all patients undergoing TSA from October 1, 2002 to May 1, 2022 with PTSD to ensure a full 2-year follow-up. These patients were then 1:1 propensity score-matched to patients without PTSD. Postoperative prescriptions and healthcare utilization rates were analyzed at 5 days, 14 days, and 30 days postoperatively. Associated complications were analyzed at 30 and 90 days. Arthroplasty complications were analyzed at 90 days, 1 year, and 2 years postoperatively.

RESULTS

A total of 44,648 patients undergoing TSA were identified. After propensity score matching, 929 patients were available in each cohort for analysis. There was no difference between postoperative emergency department visits and hospitalizations at all time points between the 2 cohorts. At 14 days, patients with PTSD had an average of 2.4 opioid prescriptions compared to 2.1 for those without PTSD (P < .001). At 30 days, patients with PTSD had an average of 3.1 opioid prescriptions compared to 2.7 for those without PTSD (P = .002). There was no difference between the 2 cohorts for all medical and orthopedic-related complications at all follow-up time points.

CONCLUSION

TSA patients with pre-existing PTSD were found to have higher healthcare utilization with respect to postoperative opioid prescriptions at 14 and 30 days postoperatively compared to their propensity-matched cohort without PTSD, even when controlling for additional mental health conditions, preoperative opioid analgesics, and other psychiatric medications. This information can be used to improve patient education for those with PTSD preoperatively and postoperatively, specifically as it relates to the use of opioids.