Anxiety but not Depression Is Associated With Increased Health Care Utilization Following Lumbar Fusion

Area of Science:

• Spine surgery outcomes
• Health economics
• Mental health comorbidities

Background:

• Lumbar fusion procedures are increasing in the US, creating a significant healthcare burden.
• Patient comorbidities are a key factor influencing postoperative costs.
• Understanding the impact of mental health conditions on healthcare utilization is crucial.

Purpose of the Study:

• To examine the association between anxiety, depression, and opioid dependence and 1-year healthcare utilization post-lumbar fusion.
• To identify specific interventions contributing to increased costs in patients with mental health comorbidities.
• To inform cost-effective management strategies for lumbar fusion patients.

Main Methods:

• Observational cohort study analyzing a national commercial claims database (MarketScan).
• Included patients undergoing single-level lumbar fusion between January 1, 2018, and December 31, 2018.
• Categorized patients by prior diagnosis of anxiety, depression, or opioid dependence, assessing 1-year postoperative intervention costs.

Main Results:

• The study included 4245 patients; 19.2% had anxiety, 19.2% had depression, and 2.6% had opioid dependence.
• Average 1-year postoperative cost was $8641 ± $19,661.
• Anxiety (OR 1.41) and opioid dependence (OR 1.82) were associated with higher costs. Anxiety added $2,272 to costs, and pain medication costs were 4.2 times higher for opioid-dependent patients.

Conclusions:

• Mental health comorbidities significantly impact healthcare utilization after lumbar fusion.
• Anxiety is a primary driver of increased healthcare costs post-lumbar fusion.
• Targeted interventions and cost-management strategies are needed for patients with these comorbidities.