Economic Effects of Anti-Depressant Usage on Elective Lumbar Fusion Surgery

Document Type : RESEARCH PAPER

Authors

1 Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA

2 Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA

3 Department of Psychiatry, Thomas Jefferson University, Philadelphia, PA, USA

4 Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

5 Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

 
Background:
It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression. 

Methods:

This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion. Of those 142 patients, 41 patients were chronically using an antidepressant medication that considered as a "study group", and 101 patients were not taking an antidepressant medication that considered as a "control group". Data was collected for this cohort regarding antidepressant usage patient demographics, length of stay (LOS), age-adjusted Charlson comorbidity index scores and cost. Costs were compared between those with a concomitant antidepressant usage and those without antidepressant usage using multivariate analysis.
Results:
Patients using antidepressants and those with no history of antidepressant usage were similar in terms of gender, age and number of operative levels. The LOS demonstrated a non-significant trend towards longer stays in those using anti-depressants. Total charges, payments, variable costs and fixed costs were all higher in the antidepressant group but none of the differences reached statistical significance. Using Total Charges as the dependent variable, gender and having psychiatric comorbidities were retained independent variables. Use of an antidepressant was independently predictive of a 36% increase in Total Charges . Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost . Male gender was predictive of a 30% increase in Total Charges .

Conclusion:

This study suggests use of antidepressant in patients who undergo elective spine fusion compared with control group is associated with increasing total cost and length of hospitalization, although none of the differences reached statistical significance.

Keywords


1. Walid MS, Robinson JS Jr. Economic impact of
comorbidities in spine surgery. J Neurosurg Spine.
2011; 14(3):318-21.
2. Walid MS, Zaytseva NV. Prevalence of mood-altering
and opioid medication use among spine surgery
candidates and relationship with hospital cost. J Clin
Neurosci. 2010; 17(5):597-600.
3. Rasouli MR, Menendez ME, Sayadipour A, Purtill JJ,
Parvizi J. Direct cost and complications associated
with total joint arthroplasty in patients with
preoperative anxiety and depression. J Arthroplasty.
2016; 31(2): 533–6.
4. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A
new method of classifying prognostic comorbidity in
longitudinal studies: development and validation. J
Chronic Dis. 1987; 40(5):373–83.
5. Deyo RA, Cherkin DC, Ciol MA. Adapting a
clinical comorbidity index for use with ICD-9-CM
administrative databases. J Clin Epidemiol. 1992;
45(6):613-9.
6. George SZ, Coronado RA, Beneciuk JM, Valencia
C, Werneke MW, Hart DL. Depressive symptoms,
anatomical region, and clinical outcomes for
patients seeking outpatient physical therapy for
musculoskeletal pain. Phys Ther. 2011; 91(3):358-72.
7. Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H,
Savolainen S, et el. Depression and associated factors
in patients with lumbar spinal stenosis. Disabil
Rehabil. 2006; 28(7):415-22.
8. Sinikallio S, Aalto T, Airaksinen O, Lehto SM, Kröger
H, Viinamäki H. Depression is associated with a
poorer outcome of lumbar spinal stenosis surgery:
a two-year prospective follow-up study. Spine (Phila
Pa 1976). 2011; 36(8):677-82.
9. Zatzick DF, Kang SM, Kim SY, Leigh P, Kravitz R, Drake
C, et al. Patients with recognized psychiatric disorders
in trauma surgery: incidence, inpatient length of stay,
and cost. J Trauma. 2000; 49(3):487-95.
10. Ebrahimzadeh MH, Shojaee BS, Golhasani-Keshtan
F, Moharari F, Kachooei AR, Fattahi AS. Depression,
anxiety and quality of life in caregiver spouses
of veterans with chronic spinal cord injury. Iran J
Psychiatry. 2014; 9(3):133-6.
11. Von Korff M, Crane P, Lane M, Miglioretti DL, Simon
G, Saunders K, et al. Chronic spinal pain and physicalmental
comorbidity in the United States: results
from the national comorbidity survey replication.
Pain. 2005; 113(3):331–9.
12. Baumeister H, Knecht A, Hutter N. Direct and indirect
costs in persons with chronic back pain and comorbid
mental disorders--a systematic review. J Psychosom
Res. 2012; 73(2):79-85.
13. Borckardt JJ, Madan A, Barth K, Galloway S, Balliet W,
Cawley PJ, et al. Excess health care service utilization
and costs associated with underrecognition of
psychiatric comorbidity in a medical/surgical
inpatient setting. Qual Manag Health Care. 2011;
20(2):98-102.
14. Konnopka A, Heinrich S, Zieger M, Luppa M, Riedel-
Heller SG, Meisel HJ, et al. Effects of psychiatric
comorbidity on costs in patients undergoing disc: a
cross-section study. Spine J. 2011; 11(7):601-9.
15. Hochlehnert A, Niehoff D, Wild B, Jünger J, Herzog W,
Löwe B. Psychiatric comorbidity in cardiovascular
inpatients: costs, net gain, and length of
hospitalization. J Psychosom Res. 2011; 70(2):135-9.