Patients with anxiety and depression who undergo rotator cuff repair are more likely to have increased opioid use and health care costs, according to new research.
Making the Link of Rotator Cuff Repair and Opioid Use
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#rotatorcuffrepairSecondary#arthroscopy#opioiduse
In the study, “Increased Health Care Costs and Opioid Use in Patients With Anxiety and Depression Undergoing Rotator Cuff Repair,” published in the October 2020 issue of The Journal of Arthroscopy, the researchers wanted to evaluate the impact mood disorders have on opioid use and medical costs after arthroscopic rotator cuff repair. They also wanted to understand the prevalence of anxiety and depression in this patient population.
They used a large claims database to identify 170,329 patients who had been treated with the procedure between October 2010 and December 2015. Slightly more than half of the patients were male. All patients were then screened for insurance claims relating to either anxiety or depression. Of these patients, 46,737 (27.4%) had comorbid anxiety or depression.
The researchers compared net medical costs and opioid use both 1 year preoperatively and 1 year postoperatively between patients with and without mood disorders.
Overall, the 1-year postoperative cost was 7.05% higher for those with a preoperative mood disorder than for those without one. This was even after adjustment for preoperative cost, sex, age and both preoperative and postoperative opioid use.
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 significantly higher in those with depression or anxiety.
The researchers wrote, “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.”
They added, “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.”
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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