情绪障碍与膝关节软骨修复术后患者围手术期阿片类药物使用量和医疗保健费用增加相关。
Mood Disorders Are Associated with Increased Perioperative Opioid Usage and Health Care Costs in Patients Undergoing Knee Cartilage Restoration Procedure.
机构信息
Department of Orthopedic Surgery & Sports Medicine, University of Kentucky, Lexington, KY, USA.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Cartilage. 2022 Jan-Mar;13(1):19476035221087703. doi: 10.1177/19476035221087703.
OBJECTIVE
To identify the prevalence of mood disorder diagnoses in patients undergoing cartilage transplantation procedures and determine the relationship between mood disorders, opioid usage, and postoperative health care costs.
DESIGN
Patients with current procedural terminology (CPT) codes for osteochondral autograft transplantation (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI) were identified in the Truven Health Marketscan database (January 2009-September 2014). Patients were grouped based on having a preoperative mood disorder diagnosis (preMDD). Preoperative opioids, postoperative opioids ≥90 days, and health care costs within the year postoperative were compared for those with and without mood disorders. Costs were analyzed, adjusting for preoperative cost, sex, age, and opioid usage, for those with and without mood disorders.
RESULTS
A total of 3,682 patients were analyzed (ACI: 690, OAT: 1,294, OCA: 1,698). A quarter of patients had preMDD (ACI: 25.4%, OAT: 20.6%, OCA: 22.7%). Postoperative opioid use was more prevalent in preMDD patients (OAT: 37.1% vs. 24.1%, < 0.001; OCA: 30.4% vs. 24.8%, = 0.032; ACI: 33.7% vs. 26.2%, = 0.070) (odds ratio [OR] ranged from 1.29 to 1.86). First-year postoperative log-transformed costs were significantly greater for preMDD patients (ACI: $7,733 vs. $5,689*, = 0.012; OAT: $5,221 vs. $3,823*, < 0.001; OCA: $6,973 vs. $3,992*, < 0.001; *medians reported). The estimated adjusted first postoperative year cost increase for preMDD OCA patients was 41.7% ( < 0.001) and 28.0% for OAT patients ( = 0.034). There was no statistical difference for ACI patients ( = 0.654).
CONCLUSION
Cartilage transplantation patients have a high prevalence of preoperative mood disorders. Opioid use and health care costs were significantly greater for patients with preoperative mood disorder diagnoses.
LEVEL OF EVIDENCE
Level III, retrospective therapeutic study.
目的
确定接受软骨移植手术的患者中情绪障碍诊断的患病率，并确定情绪障碍、阿片类药物使用与术后医疗保健费用之间的关系。
设计
在 Truven Health Marketscan 数据库（2009 年 1 月至 2014 年 9 月）中，根据当前手术术语（CPT）代码确定接受骨软骨自体移植物移植（OAT）、骨软骨同种异体移植（OCA）和自体软骨细胞植入（ACI）的患者。根据术前是否存在情绪障碍诊断（preMDD）对患者进行分组。比较有和没有情绪障碍的患者的术前阿片类药物、术后 90 天以上的阿片类药物以及术后一年内的医疗保健费用。对有和没有情绪障碍的患者进行调整，分析基于术前成本、性别、年龄和阿片类药物使用的成本。
结果
共分析了 3682 例患者（ACI：690，OAT：1294，OCA：1698）。四分之一的患者有 preMDD（ACI：25.4%，OAT：20.6%，OCA：22.7%）。术前有情绪障碍的患者术后使用阿片类药物更为普遍（OAT：37.1%比 24.1%，<0.001；OCA：30.4%比 24.8%，=0.032；ACI：33.7%比 26.2%，=0.070）（比值比范围为 1.29 至 1.86）。有 preMDD 的患者第一年的术后日志转换费用显著更高（ACI：$7733 比 $5689*，=0.012；OAT：$5221 比 $3823*，<0.001；OCA：$6973 比 $3992*，<0.001；*报告中位数）。预 MDD 患者 OCA 的第一年术后成本增加估计调整后为 41.7%（<0.001），OAT 患者为 28.0%（=0.034）。ACI 患者没有统计学差异（=0.654）。
结论
软骨移植患者术前情绪障碍患病率较高。术前有情绪障碍诊断的患者阿片类药物使用和医疗保健费用明显更高。
证据水平
三级，回顾性治疗研究。
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