Alexander Abigail J, Empey Rebecca M, Horns Joshua John, McGarrity Larissa A, Das Rupam, Morrow Ellen H, Ibele Anna R
Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.
Section of Psychology, Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah.
Ann Surg. 2025 Jun 12. doi: 10.1097/SLA.0000000000006780.
The objective of this study was to analyze changes in mental health services utilization and substance use treatment following bariatric surgery from a large commercial insurance claims database.
Mental health and substance use screenings are important components of evaluation prior to bariatric surgery. Long-term mental health services and substance use treatment utilization trends post-operatively have not been previously examined.
Using the Merative MarketScan database of commercial health insurance claims from 2011-2019, bariatric surgery patients were assessed for patterns of mental health and substance treatment utilization over 3 time points: pre-surgery (first MarketScan claim to 6 months before surgery), peri-surgery (6 months before-6 months after surgery), and post-surgery (>6 months after surgery). Rates of outpatient mental health visits, psychiatric medication prescription, inpatient psychiatric services, and substance use disorder treatment were extracted. We calculated standardized rates in person-months (pms) and ran generalized estimating equations with Poisson distribution to test for differences at each time interval.
There were modest increases in the incidence rate ratio from the pre- to-post-surgical period for inpatient psychiatric encounters (1.721 (1.481-2.00)), community mental health visits (1.325 (1.005-1.748)), outpatient psychiatrist visits (1.311 (1.255-1.37)), therapist visits (1.281(1.233-1.341)), antidepressant refills (1.154 (1.139-1.169)) and anxiolytic refills (1.418 (1.376-1.462)). However, there was a dramatic increase in encounters for substance use treatment (3.795 (3.289-4.378).
Health service utilization rates for substance use disorder treatment significantly increased postoperatively. Further investigation is needed to understand how to reduce risks and best to support these patients, particularly in the long-term post-operative period.
本研究的目的是通过一个大型商业保险理赔数据库，分析减肥手术后心理健康服务利用情况和物质使用治疗的变化。
心理健康和物质使用筛查是减肥手术前评估的重要组成部分。术后长期心理健康服务和物质使用治疗利用趋势此前尚未得到研究。
利用2011年至2019年商业健康保险理赔的Merative MarketScan数据库，对减肥手术患者在3个时间点的心理健康和物质治疗利用模式进行评估：术前（首次MarketScan理赔至手术前6个月）、围手术期（手术前6个月至手术后6个月）和术后（手术后>6个月）。提取门诊心理健康就诊率、精神科药物处方率、住院精神科服务率和物质使用障碍治疗率。我们计算了每人月（pms）的标准化率，并使用泊松分布的广义估计方程来检验每个时间间隔的差异。
从术前到术后，住院精神科会诊（1.721（1.481 - 2.00））、社区心理健康就诊（1.325（1.005 - 1.748））、门诊精神科医生就诊（1.311（1.255 - 1.37））、治疗师就诊（1.281（1.233 - 1.341））、抗抑郁药续方（1.154（1.139 - 1.169））和抗焦虑药续方（1.418（1.376 - 1.462））的发病率比值有适度增加。然而，物质使用治疗的会诊有显著增加（3.795（3.289 - 4.378））。
物质使用障碍治疗的卫生服务利用率在术后显著增加。需要进一步调查以了解如何降低风险并最好地支持这些患者，特别是在术后长期阶段。
