Self-loathing aspects of depression reduce postoperative opioid cessation rate
| Autor: | Sean Mackey, Jarred Younger, Jennifer M. Hah, Charlie K. M. Wang, Ian Carroll, F. Dirbas, Jodie A. Trafton, P. Barelka, Stuart B. Goodman, Rebecca McCue, M. Gillespie, Bing M. Wang, Peter C. Schmidt, Keith Humphreys |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Multivariate analysis Time Factors Preoperative care Article medicine Clinical endpoint Humans Longitudinal Studies Prospective Studies Prospective cohort study Depression (differential diagnoses) Aged Univariate analysis Pain Postoperative business.industry Depression Beck Depression Inventory General Medicine Middle Aged Self Concept Analgesics Opioid Anesthesiology and Pain Medicine Opioid Anesthesia Female Neurology (clinical) business medicine.drug |
| Zdroj: | Pain medicine (Malden, Mass.). 15(6) |
| ISSN: | 1526-4637 |
| Popis: | Objective We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%–64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery. Methods We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. Results The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75–0.99, P value 0.037). Conclusions Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use. |
| Databáze: | OpenAIRE |
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