Depression, anxiety increased opioid use, health care costs after hip arthroscopy
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Patients with both femoroacetabular impingement and depression or anxiety had significantly greater opioid use and health care costs before and after hip arthroscopy than those who had femoroacetabular impingement alone, according to published results.
Among 14,830 patients with femoroacetabular impingement (FAI) who underwent hip arthroscopy between October 2010 and December 2015, Cale A. Jacobs, PhD, of the University of Kentucky, and colleagues compared health care costs in the year before and after surgery between patients with and those without depression or anxiety. The number of patients who filled narcotic pain prescriptions within 180 days before surgery and greater than 60 or 90 days after hip arthroscopy were also compared between the groups, according to researchers.
Results showed 35.1% of patients had depression or anxiety claims before surgery. Researchers found opioid-related prescriptions were filled by a significantly greater proportion of patients with preoperative depression or anxiety in the 6 months before surgery and both greater than 60 and 90 days after surgery. Before and following surgery, patients with preoperative depression or anxiety had significantly greater health care costs, according to results.
Jacobs and colleagues noted treatment strategies that specifically target patients with FAI and comorbid mental health diagnoses need to be developed to “both improve the likelihood of a successful clinical outcome, as well as to lessen the risk of chronic opioid use and health care utilization costs.” Surgeons and health care providers should also counsel patients with depression or anxiety on the increased risk of prolonged opioid use before surgery, according to the authors.
“Because of the increased postoperative opioid use and previously reported inferior patient-reported outcomes for hip arthroscopy patients with depression or anxiety, we must partner with our mental health colleagues to improve outcomes for this at-risk patient population,” Jacobs told Healio Orthopedics. “Multidisciplinary clinical care pathways must be established that not only involve perioperative screening, but also viable treatment options for the underserved group. At the University of Kentucky, we have initiated programs involving cognitive behavioral therapy for patients with knee osteoarthritis and are working to establish similar programs for femoroacetabular impingement and orthopedic trauma patients as well.” – by Casey Tingle
Disclosures: Jacobs reports he receives grants from Smith & Nephew, Medtronic, Zimmer Biomet and Aesculap. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Dean K. Matsuda, MD
This timely study demonstrates that health care costs and opioid use before and after hip arthroscopy were significantly greater for FAI patients with mental health disorders. Preoperative pain has been demonstrated to correlate more with mental health status than with size of labral tear and/or bony FAI deformities. Depression and anxiety are associated with increased pain and lower function following hip arthroscopy, but these are not contraindications for hip arthroscopic treatment, as studies have demonstrated significant clinical benefit in those with anxiety/depression. FAI syndrome is an equal opportunist, and patients with mental health disorders may perceive as much (or possibly more) pain than those without anxiety and/or depression.
Pain has been shown to be a complex perceived response to inflammatory and neuropathic stimuli that may be amplified by central sensitization which, in turn, can worsen depression. Moreover, patients with anxiety and depression often have poor coping skills including pain catastrophizing.
I believe the key message for surgeons is to be vigilant of the signs of depression/anxiety, properly counsel patients that this may impact surgical outcome, postoperative pain and pain management. In some cases, preoperative intervention with a qualified mental health provider and pain management specialist may be in everyone's interest.
Marina del Ray, California
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