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

Abstract

Observational cohort study. The purpose of this study is to describe the association between 3 prevalent mental health comorbidities and 1-year health care utilization after lumbar fusion surgery. The volume of lumbar fusion procedures in the United States is increasing, leading to a substantial postoperative health care burden. Postoperative costs associated with these procedures may be driven by a number of factors, including patient comorbidities. A large national commercial claims database (MarketScan, Merative) was analyzed. Patients who underwent a single-level lumbar fusion from January 1, 2018, to December 31, 2018, were included in the study. Patients were categorized based on the presence of a prior diagnosis of opioid dependence, anxiety, or depression. The main outcome was the total cost for postoperative interventions in the 1-year period after lumbar fusion. Interventions examined in this study included: (i) physical therapy, (ii) injections, (iii) pain medication, (iv) imaging, (v) clinic visits, and (vi) subsequent spine surgeries. The study population included 4245 patients (anxiety, 19.2%; depression; 19.2%; opioid dependence, 2.6%). The average total 1-year postoperative cost per patient was $8641 ± 19,661. Higher-cost patients were more likely to be those with a prior diagnosis of anxiety (OR 1.41, 95% CI 1.18-1.69, P <0.001) or opioid dependence (OR 1.82, 95% CI 1.23-2.69, P <0.01). Anxiety was found to be associated with the largest relative increases in total costs compared with patients without this diagnosis (+$2,272, P =0.003). The cost of pain medication was 4.2 times higher ( P <0.001) among patients with a prior diagnosis of opioid dependence. Patients undergoing single-level lumbar fusion have varying levels of health care utilization, with a prior diagnosis of anxiety likely to drive higher costs.