A new acute pain service fee addition in Japan: a nationwide study based on a reimbursement claims database

Postoperative pain management is critical for psychological and physical patient outcomes. In April 2022, the Japanese government introduced a new Acute Pain Service (APS) fee addition into the health care reimbursement system to promote structured APS implementation. This study aims to describe the current status of APS addition and explore its association with patient and hospital outcomes.

We conducted a retrospective study using a nationwide claims database. Patients who underwent surgery with general anesthesia from April 2022 to June 2023 were included. Surgical procedures were categorized into 15 departments or classified as "mixed," and APS addition claim frequency was summarized. Propensity score matching and multivariable regression analyses were performed.

A total of 14,022 patients with APS addition and 551,315 without were included. The relative frequency of APS addition was 2.48%, with the highest in esophageal surgery (11.8%). APS addition claims gradually increased over time. Propensity score matching showed no apparent differences in total hospitalization costs or length of stay between groups. However, significant interactions were observed between APS addition and patient age. Among 90-year-old patients, the estimated mean cost reduction [95% confidence interval (CI)] was 4.6% [2.1%, 7.0%] for males and 4.7% [2.4%, 6.9%] for females, while the estimated mean [95% CI] reduction in length of stay was 6.7% [3.0%, 10.3%] and 8.9% [5.6%, 12.1%], respectively.

Although the overall effects of APS addition were minimal, age-stratified analyses suggest that it may be associated with improved outcomes among older patients. These exploratory findings warrant further investigation.