Poster 192: Depressive and Anxiety Disorders Increase Risk for Continued Biceps Pain Following Arthroscopic Biceps Tenodesis

Abstract

Objectives: Arthroscopic suprapectoral biceps tenodesis (ASPBT) may result in postoperative biceps pain. Previous studies have revealed associations between demographic or intraoperative factors and shoulder pain, but with conflicting results. No study has exclusively investigated predictors of biceps pain following ASPBT. The purpose of this study was to evaluate factors associated with postoperative biceps pain following ASPBT while also determining the clinical impact of postoperative biceps pain. We hypothesized that younger age and pre-existing diagnoses of chronic pain syndromes would be associated with increased postoperative biceps pain. Methods: A retrospective study comprised of patients that underwent ASPBT was completed. Groups were categorized by the presence (BP+) or absence (BP-) of postoperative biceps pain. Differences between continuous variables were tested with two-sample t-tests and differences between categorical variables were tested with the chi-squared or Fisher’s exact test. Variables collected at different postoperative timepoints were first analyzed using a linear mixed model or generalized linear mixed model with fixed effects for group, timepoint, the group*timepoint interaction, and a random subject effect. Post-hoc comparisons were analyzed and p-values were adjusted for multiple testing with the Benjamini-Hochberg procedure. Results: A total of 461 (47 BP+, 414 BP-) patients met criteria for analysis. A lower mean age was observed in the BP+ group (p<0.01). Diagnoses of major depressive disorder (MDD) (p=0.03) and any anxiety disorder (p<0.01) were more prevalent in the BP+ group. Prescription medication with selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (p<0.01) and atypical antidepressants (p=0.01) was more prevalent in the BP+ group. Subacromial decompression (SAD) was performed less frequently in the BP+ group (p<0.01). Conclusions: Younger age, diagnosis of MDD or any anxiety disorder, as well as the use of psychotropic medications were predictive of postoperative biceps pain following ASPBT. The study also observed lower odds of developing postoperative biceps pain in patients undergoing concomitant SAD. Postoperative biceps pain after ASPBT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ASPBT in younger patients, patients diagnosed with MDD or anxiety, and patients taking psychotropic medications should be carefully considered given the correlation to postoperative biceps pain and inferior outcomes. [Table: see text][Table: see text]