Associations Between Preoperative Depression, Hysterectomy, and Postoperative Opioid Use

Abstract

Study Objective Preoperative depression has been linked to adverse outcomes following hysterectomy, including increased acute and chronic postoperative pain. The goal of this study was to determine whether preoperative depression is associated with increased opioid use following hysterectomy. Design Retrospective analysis of women who underwent benign hysterectomy between January 2001 and March 2015. Women without opioid prescriptions 180 days prior to surgery were identified in IBM Watson/Truven Health Analytics MarketScan® database, a large claims database and were required to have continuous enrollment in one of these health plans for 180 days before and after hysterectomy. Persistent opioid use was defined as an opioid fill during the perioperative period (10 days before to 30 days after surgery) and an additional opioid fill 90-180 days after hysterectomy. Setting N/A Patients or Participants 531,059 women who underwent hysterectomy for non-cancer causes during the study period; 72% (n=383,243) were opioid naive and included. Interventions N/A Measurements and Main Results Multivariable log-binomial regression was used to assess whether women with preoperative depression had a higher risk of persistent opioid use and 30-day complications, after adjusting for demographics, comorbidities, and surgical characteristics. The prevalence of pre-surgical depression was 20% (n=75,230). 74% of women were given an opioid prescription during the perioperative period and, of those that initiated, 8% had at least one additional opioid fill 90-180 days after their hysterectomy. After adjustment, women with depression were only 8% more likely to get an initial opioid fill (RR 1.08, 9%%CI 1.07, 1.08) but were 43% more likely to have persistent opioid use (RR 1.43, 95% CI 1.39, 1.47). Women with depression were also more likely to have any surgical complication (RR 1.04, 95% CI 1.03, 1.06). Conclusion In our cohort, women with preexisting depression had a greater risk of persistent opioid use post-hysterectomy suggesting chronic pain beyond the immediate recovery period and potentially increased risk of opioid dependence.