(363) Antidepressant Use in Patients with a History of Depression is Associated with Reduced Opioid Use after Total Knee Arthroplasty

Abstract

Chronic post-surgical pain (CPSP) affects up to 40% of patients and is associated with prolonged postoperative opioid use. Depression is one risk factor for CPSP, but it is unknown if antidepressants modulate the risk for CPSP or prolonged postoperative opioid use in patients undergoing procedures at high-risk for CPSP. This retrospective cohort study utilized the records of Veterans Affairs patients who underwent a total knee arthroplasty (TKA) between April 2012 – April 2016. Selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) use was recorded. Exclusion criteria were no depression diagnosis, opioid use preoperatively, other antidepressant use, and chronic pain diagnoses. Outcomes included morphine equivalents through postoperative day one and opioid use through 30, 90, and 365 days after surgery. Generalized linear models were created to adjust for confounding covariates, and a secondary analysis stratified outcomes by antidepressant class. The study cohort included 1,655 TKAs after applying all exclusion criteria, and it was 90.6% male and 77.1% white with a mean age of 65 years. Patients meeting inclusion criteria and using an SSRI or SNRI comprised 454 cases (27.4%). After adjustment for age, BMI, sex, race, general or regional anesthesia, non-opioid adjunct pain medication use, and comorbidities recorded in the VA Surgical Quality Improvement Program (VASQIP), SSRI or SNRI use was associated with reduced opioid use through 30 days after surgery (OR = 0.74 (0.57, 0.95), p = 0.020). In the secondary analysis, SSRI use was associated with reduced opioid use through 90 days after surgery compared to SNRI use (OR = 0.35 (0.14, 0.89), p = 0.022). Perioperative SSRI or SNRI use, in patients with depression, is associated with reduced prescription opioid use 30 days after TKA. Prospective research is warranted to elucidate if there is a role for antidepressants as non-opioid analgesics in specific surgical populations.