Preoperative Anxiety Does Not Increase Opioid Use After Rotator Cuff Surgery, Study Finds

A new research study led by physicians and staff at Hoag Orthopedic Institute found that preoperative anxiety levels do not significantly influence postoperative opioid consumption in patients undergoing arthroscopic rotator cuff repair. The study potentially opens new paths for pain management strategies while questioning the relationship of anxiety to increased opioid use.

The level 2 prospective cohort study, published in the April Orthopedic Journal of Sports Medicine, found no significant connection between total opioid consumption, duration of opioid use or daily opioid use and preoperative anxiety levels.

“The results of this study concluded that mental health disorders alone should not drive prescribing decisions,” said Hafiz F. Kassam, MD, director of shoulder reconstruction at Hoag Orthopedic Institute (HOI) and one of the study’s authors. “Our study found no meaningful impact and suggests that anxiety levels by themselves are not a reliable forecaster of opioid use.”

Rotator cuff tears are one of the most common shoulder conditions affecting approximately 30 percent of individuals over age 60 and more than 60 percent of those over age 80.

The study was based on 64 patients who received the same average dose of morphine equivalents following arthroscopic rotator cuff repair surgery. Preoperative anxiety was measured using a self-report patient questionnaire that tracked the frequency of anxiety symptoms of fear, worry or hyperarousal.

Surgeons play a critical role in limiting unnecessary exposure to opioid medications. While previous studies have linked diagnosed anxiety disorders to prolonged opioid use, this research is among the first to evaluate quantified anxiety levels.

“Providers have often used blanket labels of a mental health diagnoses to stratify patients as high-risk for complications such as opioid dependence before they ever reach the operating room,” said Dr. Kassam. “Surgery stresses everyone. It does not equal a psychiatric diagnosis, and it does not predict who will struggle postoperatively.”

In addition to Dr. Kassam, co-authors of the study include Evan R. Simpson, BS, Kalyn Smith, BA, Abhay Mathur, MD, Patrick Saunders, MD, David Gazzaniga, MD and Kevin C. Parvaresh, MD. The study was conducted at Hoag Orthopedic Institute, Irvine, Calif.