接受肩袖修复术的焦虑和抑郁患者的医疗保健费用增加和阿片类药物使用增加。
Increased Health Care Costs and Opioid Use in Patients with Anxiety and Depression Undergoing Rotator Cuff Repair.
机构信息
Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
Department of Orthopaedic Surgery & Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A.
出版信息
Arthroscopy. 2020 Oct;36(10):2655-2660. doi: 10.1016/j.arthro.2020.05.038. Epub 2020 Jun 1.
PURPOSE
To (1) quantify the prevalence of mood disorders in patients undergoing arthroscopic rotator cuff repair (RCR) by use of a large claims database and (2) compare opioid use and medical costs in the year before and the year after RCR between patients with and without comorbid mood disorders.
METHODS
A large claims database was queried to identify patients who underwent arthroscopic RCR (Current Procedural Terminology code 29827) between October 2010 and December 2015. All patients were then screened for insurance claims relating to either anxiety or depression. We compared net costs and opioid use both 1 year preoperatively and 1 year postoperatively between patients with and without mood disorders by use of an analysis of covariance.
RESULTS
A total of 170,329 patients (97,427 male patients [57.2%] and 72,902 female patients [42.8%]) undergoing arthroscopic RCR were identified. Of the 170,329 patients, 46,737 (27.4%) had comorbid anxiety or depression, and after adjustment for preoperative cost, sex, age, and both preoperative and postoperative opioid use, the 1-year postoperative cost was 7.05% higher for those with a preoperative mood disorder than for those without a mood disorder. In addition, opioid use both in the 180 days prior to surgery (36.7% vs 26.9%) and more than 90 days after surgery (33.0% vs 27.2%) was substantially greater in the group with comorbid depression or anxiety.
CONCLUSIONS
In patients with comorbid mood disorders, opioid use and health care costs were increased both preoperatively and postoperatively. The increased cost in this patient population is estimated at $62.3 million annually. In an effort to provide high-quality, value-based care, treatment strategies should be developed to identify these patients preoperatively and provide the appropriate resources needed to improve the probability of a successful surgical outcome.
LEVEL OF EVIDENCE
Level III, retrospective, comparative therapeutic study.
目的
（1）利用大型理赔数据库，量化接受关节镜肩袖修复术（RCR）的患者中情绪障碍的患病率；（2）比较伴或不伴合并情绪障碍的患者在 RCR 前后一年的阿片类药物使用情况和医疗费用。
方法
对大型理赔数据库进行查询，以确定 2010 年 10 月至 2015 年 12 月期间接受关节镜 RCR（现行程序术语代码 29827）的患者。然后，所有患者均筛查了与焦虑或抑郁相关的保险索赔。我们使用协方差分析比较了伴或不伴情绪障碍的患者术前 1 年和术后 1 年的净费用和阿片类药物使用情况。
结果
共确定了 170329 例（97427 例男性患者[57.2%]和 72902 例女性患者[42.8%]）接受关节镜 RCR 的患者。在这 170329 例患者中，46737 例（27.4%）合并有焦虑或抑郁，在校正术前费用、性别、年龄以及术前和术后阿片类药物使用后，合并术前情绪障碍的患者术后 1 年的成本比无情绪障碍的患者高 7.05%。此外，合并有抑郁或焦虑的患者术前 180 天内（36.7% vs 26.9%）和术后 90 天以上（33.0% vs 27.2%）的阿片类药物使用量均明显增加。
结论
在合并有情绪障碍的患者中，术前和术后阿片类药物的使用和医疗费用均增加。该患者人群的增加成本估计每年为 6230 万美元。为了提供高质量、基于价值的医疗服务，应制定治疗策略，以便在术前识别这些患者，并提供适当的资源，以提高手术成功的可能性。
证据等级
III 级，回顾性，对照治疗研究。
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